Background Glucose variability (GV) is considered an important factor for cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). High GV causes endothelial dysfunction and increased oxidative stress. Dipeptidyl peptidase-4 (DPP-4) inhibitors may improve endothelial function and decrease GV. The aim of this study was to investigate the effects of vildagliptin, a DPP-4 inhibitor, compared with glibenclamide in GV and endothelial function in patients with T2DM and arterial hypertension. Methods This is a prospective, randomized, open and drug-controlled study. Fifty patients older than 35 years with T2DM and hypertension without CVD were randomized to receive vildagliptin (n=25) or glibenclamide (n=25), both in added-on metformin. Laboratory tests and analysis of endothelial function were performed before and 12 weeks after treatment. Endothelial function, defined by reactive hyperemia index (RHI), was analyzed by peripheral artery tonometry (endo-PAT2000). GV was evaluated by capillary glucose with intermittent monitoring device, six measurements per day, for three days, before and after treatment. The median of standard deviation (SD) of mean blood glucose (MBG) was used to evaluate GV. Results GV decreased in the vildagliptin group (35.2 to 30.7, P =0.037) but did not change with glibenclamide (37.6 to 37.5, P =0.765). Glycated hemoglobin was similar in both groups. MBG decreased only in glibenclamide group, without difference with vildagliptin group ( P =0.374). There were no changes in the RHI in both groups and there was no correlation between GV and RHI ( P =0.658). Conclusion Vildagliptin reduces GV; however, the action on endothelial function was not demonstrated. In addition, there was no correlation between GV and endothelial function.
Os a u to r e s e s t u d a r a m o q u a d r o s e r ic o p r o t é ic o d e s e t e p a c i e n t e s c o m B la st o m ic o s e S u l-A m e r ic a n a , u tiliz a n d o a e l e t r o fo r e s e em p a p e l, a s e p a r a ç ã o c r o m at o g r á fic a e m c o lu n a d e S e p h a d e x G -200 e a im u n o e le t r o fo r e s e e m a g a r . Os p a c ie n t e s a p r e s e n t a v a m le s õ e s p u lm o n a r e s , c o m ou sem a d e n o p a t ia , ou a p e n a s a d e n o p a t ia lo c a liz a d a ou g e n e r a liz a d a e e s t a a c o m p a n h a d a ou n ã o d e le s õ e s d o tu b o g a s t r o -in t e s t in a l, r e v e la d a s p e lo R x. C h e g a r a m à c o n c lu s ã o d e q u e a B la s t o m ic o s e d e t e r m in a e le v a ç ã o d o te o r d a s im u n o g lo b u lin a s d o tip o Ig G e ig M e n ã o d o I g A , S u g e r e m q u e a s im u n og lo b u lin a s d o tip o Ig G se e le v a m c o m a f o r m a ç ã o d e g r a n u lo m a s e r e p a r a ç ã o fi b r ó t ic a . a lé m d e r e fle t ir e m a r e s p o s t a im u n e e s p e c íf ic a d o p r o c e s s o em f a s e c r ô n ic a , e n q u a n t o q u e a s d o tip o IgM a u m e n t a m d e te o r n a f a s e a g u d a ou d e a g u d iz a ç ã o d a d o e n ç a , q u a n d o os f e n ô m e n o s d e e x s u d a ç ã o e n e c r o s e se to r n a m b e m e v i d e n t e s . INTRODUÇÃOEstudos in iciais, porm enorizados, das p ro teín as do soro n a B lasto m ico se S u l-A m erican a fo ram realizados por Del Negro e F iorillo, em 1954 (2) . V erificações re la cion ad as a m u co -p ro teín a s e an ticorp os esp ecíficos fo ram fe ita s por F a v a N etto, F e rri e L acaz em 1959 i5) . B a rb o sa , e m sua tese de 1868 (1), re-estu d ou o quadro protéico em um núm ero grand e de p a c ie n tes, u tilizan d o -se da sep a ra çã o e le tro fo ré -tic a em papel. As altera çõ e s en co n tra d a s pelos au tores m ais recen tes não tro u x era m e sclarecim en to s m aiores q u an to ao com O estudo p relim in a r co n sta de ach ad os corresp o n d en tes a sete de nossos p a c ie n tes com B lasto m ico se S u l-A m e rica n a , in tern ad os no Serviço de M oléstias I n fe c ciosas da F acu ld ad e
Introduction: Glycemic variability has been considered as an important factor in the development of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). High glycemic variability causes endothelial dysfunction and increased oxidative stress. Among the drugs for T2DM, dipeptidyl peptidase-4 (DPP-4) inhibitors improve endothelial function and decrease glycemic variability. Objectives: To investigate the effects of vildagliptin, a DPP-4 inhibitor, compared with glibenclamide on the glycemic variability and endothelial function of patients with T2DM and hypertension (HT). Methods: Prospective, randomized, open, drug-controlled study. Fifty patients older than 35 years with T2DM and HT without CVD were randomized to receive vildagliptin (n=25) or glibenclamide (n=25), in addition to metformin in both groups. Laboratory tests and analysis of endothelial function were performed before and 12 weeks after treatment. Endothelial function, defined by the reactive hyperemia index (RHI), was analyzed by peripheral artery tonometry (endo-PAT2000). The glycemic variability was evaluated by capillary glycemia with intermittent monitoring device, 6 measures/day, for 3 days, before and after 12 weeks of treatment. The calculation of the standard deviation (SD) of the means of glycemia was used to evaluate the glycemic variability. Results: Glycemic variability decreased in the vildagliptin group, defined by median of SD: before 35.2 mg/dL (13.9 - 59.7) vs 30.7 mg/dL (16.1 - 64.3) after treatment (p=0.037) and did not change with glibenclamide, 37.6 (16.0 - 54.9) vs 37.5 mg/dL (16.5 - 80.03) (p=NS). Glycated hemoglobin was similar in both groups at baseline and decreased after 12 weeks, not significantly (8.3% ± 1.0 vs 8.0% ± 1.34, p=0.18 for vildagliptin, 7.9% ± 0.9 vs 7.5% ± 1.4, p=0.17 for glibenclamide). The fasting glycemia decreased in the vildagliptin (166 ± 38.7 mg/dL vs 147.5 ± 42.6 mg/dL, p=0.01) and glibenclamide groups (164 ± 43.5 mg/dL vs. 139 ± 54 mg/dL, p=0.01), with no difference between them. There were no changes in the RHI before and after treatment in both groups (2.34 ± 0.58 vs 2.24 ± 0.60, for vildagliptin, p=NS; 2.36 ± 0.51 vs 2.33 ± 0.49, p=NS for glibenclamide) and there was no difference between groups. There was no correlation between glycemic variability and RHI. Conclusions: Vildagliptin reduces glycemic variability, but has no action on endothelial function, evaluated by endo-PAT2000.
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