<p>Randomized Study Comparing Vildagliptin vs Glibenclamide on Glucose Variability and Endothelial Function in Patients with Type 2 Diabetes Mellitus and Hypertension</p>

Abstract

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.

Association of Blood Glucose Variability with Sepsis-Related Disseminated Intravascular Coagulation Morbidity and Mortality

“…Dysglycemia and high glucose variability are related to compromised endothelial function and injured endothelial cells in patients with type I and II diabetes, as well as in patients with coronary artery disease. [64][65][66] Endothelial cells play a key role in maintaining intravascular patency; 67 thus, disrupted endothelial homeostasis in septic conditions may play a fundamental role in the pathogenesis of sepsis-related DIC (36) and contribute to the high glycemic variability. Similarly, we observed that patients with the lowest glycemic variability had the lowest DIC occurrence.…”

Role of Dipeptidyl Peptidase-4 in Atherosclerotic Cardiovascular Disease in Humans and Animals with Chronic Stress

“…Recent data from laboratory and clinical studies highlighted the role of DPP family members (especially DPP-4) in ACVD. [26][27][28] Cell and tissue expression of DPP-4: DPP-4, which is one of the most potent serine peptidases, is broadly expressed in mammalian tissues, including the kidney, blood vessels, small intestine, lung, liver, brain, spleen, adipose, and heart tissues (Figure 2). 10) The observations of an early experimental study using colorimetric enzyme histochemistry demonstrated that DPP-4 activity is localized in cardiac venous capillaries.…”