P1027THE DIFFERENCES EFFECTS OF GLUCAGON LIKE PEPTIDE-1(GLP-1) ANALOGUES AND SODIUM-COTRANSPORTER 2 (SGLT-2) INHIBITORS ON TYPE 2 DIABETES PATIENTS WITH RENAL IMPAIRMENT
Authors: HIRAMATSU TAKEYUKI , OKUMURA SHOTA , Iguchi Daiki , Furuta Shinji 
Published: June 2020

Abstract

Background and Aims
Diabetes mellitus (DM) is a progressive multifactorial disease associated with cardiovascular complications. To prevent the progression of cardiovascular complications in DM patients, glycemic control is important. In this study, we examined impact on cardiac function between glucagon like peptide-1(GLP-1) analogue and sodium-glucose cotransporter-2 (SGLT-2) inhibitors to treat type 2 diabetes patients with renal impairment.

Method
A total of 125 type 2 DM patients with renal impairment were recruited for this study. All patients were divided into two groups according to the anti-diabetic agents at baseline: Group G; 0.9mg/day liraglutide, n=53, Group S; n=72; 5mg/day dapagliflozin, n=32, empagliflozin n=14, 20mg/day tofogliflozin n=19, or 50mg/day ipragliflozin n=16. Blood glucose levels, glycosylated hemoglobin (HbA1c), serum creatinine, and albuminuria were obtained 12 months before and every 3 months for 36 months. Echocardiography, ankle brachial pressure index(ABI) and cardio-ankle vascular index(CAVI) were obtained every 12 months for 36 months.

Results
At baseline, the mean age was 68.5±6.0 years, DM vintage was 12.0±6.0 years, and mean total oral pill counts was 12.0±6.0. Compared with baseline, mean total pill counts were reduced at 12 months after initiation of new anti-diabetic agents (ADA) and remained afterward (Group G; 12.3±5.3 at baseline, 8.9±4.0 at 12 months (p&lt;0.05), Group S; 11.8±4.2 at baseline, 8.6±3.4 at 12 months (p&lt;0.05)). The counts of ADAs were also decreased (Group G; 3.85±2.61 at baseline, 1.41±2.01 at 12 months (p&lt;0.01), Group S; 3.48±2.43 at baseline, 2.41±1.44 at 12 months (p&lt;0.05)). HbA1c and systolic blood pressure were significantly decreased after initiation of GLP-1 analogue or SGLT-2 inhibitor in both groups. Nevertheless, eGFRs were gradually decreased in both groups. Albuminuria indicated by urinary albumin creatinine ratio were decreased significantly after initiation of anti-diabetic agents. Left ventricular mass index (LVMI) (Group G; 135.8 at baseline, 110.2 at 12 months,114.5 at 24 months, 107.2 g/m2 at 36 months, Group S; 130.0 at baseline, 113.2 at 12 months,106.4 at 24 months, 115.9 g/m2 at 36 months) and left atrial volume index (LAVi) (Group G; 25.6 at baseline, 22.3 at 12 months, 21.4 at 24 months, 20.8 mL/m2 at 36 months, Group S; 24.0 at baseline, 21.8 at 12 months,21.7 at 24 months, 22.7 mL/m2 at 36 months) were significantly decreased in both groups. Cardiac systolic function indicated by ejection fraction (EF) and diastolic function indicated by E/e’ (Group G; 12.9 at baseline, 10.4 at 12 months, 9.4 at 24 months, 9.5 at 36 months, Group S; 12.4 at baseline, 10.6 at 12 months, 12.5 at 24 months, 12.9 at 36 months) or left atrial dimension were remained or improved only in group G. Moreover, arterial stiffness indicated by cardio-ankle vascular index (CAVI) was improved in group G (Group G; 10.2 at baseline, 9.9 at 12 months, 9.9 at 24 months, 9.9 at 36 months, Group S; 10.3 at baseline, 10.5 at 12 months, 10.6 at 24 months, 10.6 at 36 months) (Table1). With respect to admission due to cardiovascular events, cerebrovascular infarction were occurred higher in group S (3.8% vs 1.3% / yea; p&lt;0.05), congestive heart failure were higher in group G (1.9%. vs 0.5% / year; p&lt;0.05).

Conclusion
These findings suggest that liraglutide and SGLT-2 inhibitor for type 2 DM patients with renal impairment have similar effects on renal function including eGFR and albuminuria and left ventricular and atrial volume. However, liraglutide could provide more benefit for arterial stiffness than SGLT-2 inhibitors.