4.6 Effects of Combined Therapy of Empagliflozin and Linagliptin Versus Metformin and Insulin Glargine on Blood Pressure and Vascular Function in Patients with Type 2 Diabetes

Abstract

Background

Combination of insulin with oral antidiabetic drugs is a valid option, but oral combination therapy emerged as an alternative treatment in type 2 diabetes (T2DM). However, the effects on blood pressure (BP) and vascular function of such combination therapies is less clear.

Methods

In this study 101 patients with T2DM were randomized to receive either empagliflozin 10 mg and linagliptin 5 mg (E+L group) orally or metformin and insulin glargine (M+I group, with dose adjustments according to glucose levels), for 3 months. Patients underwent BP and vascular examination at baseline and after 12 weeks of treatment, including measurement of office and ambulatory BP and vascular function under clinical and ambulatory conditions by validated systems.

Results

In comparison to baseline, office, 24-hour ambulatory BP and central blood and pulse pressure (PP) values decreased significantly after 12 weeks of treatment with E+L, whereas there was no significant change in vascular parameters in the M+I group (Table 1). Comparing the 2 groups, there were significant decreases in 24-h ambulatory peripheral systolic (mean difference between the 2 groups: −5.2 ± 1.5 mmHg, p = 0.004), diastolic BP (−1.9 ± 1.0 mmHg, p = 0.036) and PP (−3.3 ± 1.0 mmHg, p = 0.007) in favour of E+L. Central systolic BP (−5.56 ± 1.9 mmHg, p = 0.009), forward pressure pulse height (−2.0 ± 0.9 mmHg, p = 0.028) and 24-h ambulatory central systolic (−3.6 ± 1.4 mmHg, p = 0.045), diastolic BP (−1.95 ± 1.1 mmHg, p = 0.041) and 24-h pulse wave velocity (−0.14 ± 0.05 m/s, p = 0.043) were reduced to a greater extent in the E+L group than in the M+I group.

Conclusion

The combination of E+L significantly improves BP and vascular function in contrast to the combination of M+I.

Table 1