Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .
The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus
Background Individuals with type 1 diabetes mellitus are at high risk for the development of hypertension , contributing to cardiovascular complications . Hyperglycaemia-mediated neurohormonal activation increases arterial stiffness , and is an important contributing factor for hypertension . Since the sodium glucose cotransport-2 ( SGLT2 ) inhibitor empagliflozin lowers blood pressure and HbA1c in type 1 diabetes mellitus , we hypothesized that this agent would also reduce arterial stiffness and markers of sympathetic nervous system activity . Methods Blood pressure , arterial stiffness , heart rate variability ( HRV ) and circulating adrenergic mediators were measured during clamped euglycaemia ( blood glucose 4–6 mmol/L ) and hyperglycaemia ( blood glucose 9–11 mmol/L ) in 40 normotensive type 1 diabetes mellitus patients . Studies were repeated after 8 weeks of empagliflozin ( 25 mg once daily ) . Results In response to empagliflozin during clamped euglycaemia , systolic blood pressure ( 111 ± 9 to 109 ± 9 mmHg , p = 0.02 ) and augmentation indices at the radial ( -52 % ± 16 to -57 % ± 17 , p = 0.0001 ) , carotid ( + 1.3 ± 1 7.0 to -5.7 ± 17.0 % , p < 0.0001 ) and aortic positions ( + 0.1 ± 13.4 to -6.2 ± 14.3 % , p < 0.0001 ) declined . Similar effects on arterial stiffness were observed during clamped hyperglycaemia without changing blood pressure under this condition . Carotid-radial pulse wave velocity decreased significantly under both glycemic conditions ( p ≤ 0.0001 ) , while declines in carotid-femoral pulse wave velocity were only significant during clamped hyperglycaemia ( 5.7 ± 1.1 to 5.2 ± 0.9 m/s , p = 0.0017 ) . HRV , plasma noradrenalin and adrenaline remained unchanged under both clamped euglycemic and hyperglycemic conditions . Conclusions Empagliflozin is associated with a decline in arterial stiffness in young type 1 diabetes mellitus subjects . The underlying mechanisms may relate to pleiotropic actions of SGLT2 inhibition , including glucose lowering , antihypertensive and weight reduction effects . Trial registration Clinical trial registration :
Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .