Factors Associated with the Remission of Type 1 Diastolic Dysfunction after Dapagliflozin Treatment in Patients with Type 2 Diabetes

Abstract

Patients with type 2 diabetes (T2DM) are at high risk of developing cardiovascular disease and heart failure (HF), both with preserved and reduced ejection fraction of the left ventricle. Previous research demonstrated that dapagliflozin treatment is associated with the remission of type 1 diastolic dysfunction (DD1) in patients with T2DM. The main aim of this study was to evaluate the possible baseline predictors associated with the remission of DD1 in patients with T2D after one year of dapagliflozin treatment. In this prospective and observational study, 45 patients with T2DM were evaluated before and after one year of treatment with 10 mg dapagliflozin daily added to their background therapy. In the studied group, 73.3% (33/45) of the patients had DD1 at baseline. The primary outcome of this research was DD1 remission. DD1 remission was associated with improvement of liver stiffness, an increase in estimated glomerular filtration rate (eGFR), and a decrease in hemoglobin A1c (HbA1c). Independent predictors for the remission of DD1 were a more than 0.4 kPa difference in the initial stiffness score and the 1-year assessment fibrosis score and a duration of diabetes ≤8 years. Age, body mass index (BMI), or patient weight after one year did not influence the DD1 outcome. Patients with a T2DM duration of less than eight years have the additional benefit of DD1 remission associated with dapagliflozin treatment beyond the conventional benefits such as improvements in glycemic control, cardiovascular, renal, and hepatic risk reductions. In patients with T2DM, the remission of DD1 was associated with decrease of liver stiffness.

Predictors of Epicardial Fat Volume Decrease after Dapagliflozin Treatment in Patients with Type 2 Diabetes

“…The present research is a prospective, consecutive-case, population-based study that investigated for the first time the predictive power of atherogenic biomarkers for the response to dapagliflozin therapy in a population of T2D patients. A previous study conducted by our team proved that dapagliflozin reduces the epicardial fat volume after only six months of treatment, regardless of glycemic control or bodyweight reduction [19].…”

“…Regarding the management of T2D, according to the latest guidelines [17], sodium-glucose-2 co-transporter inhibitors (SGLT2i) should be the first pharmaceutical step after metformin in patients with T2D and heart failure. In a previous study that supports the recommendations of the American Diabetes Association (ADA) guidelines, dapagliflozin, an SGLT2i, demonstrated beneficial effects in type 1 diastolic dysfunction remission, especially in T2D patients with a diabetes evolution of up to 8 years [18] in association with an epicardial adipose fat volume (EFV) decrease, beyond the glycemic control [19].…”