title: Left ventricular diastolic function in patients with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor- a pilot study.
abstract: BACKGROUND
  Blood glucose control is fundamental albeit not enough to prevent diabetic macrovascular complications. Dipeptidyl peptidase-4 (DPP-4) inhibitors are effective in improving metabolic parameters in patients with type 2 diabetes mellitus (T2DM) but little is known about its cardiovascular effects. We compared the DPP-4 inhibitor sitagliptin with bedtime NPH insulin (NPH) as add-on therapy in patients with T2DM, aiming to ascertain which drug would have additional cardioprotective effects.
  
  
  METHODS
  Thirty-five T2DM patients inadequately controlled with metformin plus glyburide were randomized to receive sitagliptin (n = 18) or NPH (n = 17) for 24 weeks. Fasting plasma glucose, HbA1c, lipid profile, C-reactive protein, active glucagon-like peptide (aGLP-1) levels, 24-hour ambulatory blood pressure measurement and comprehensive 2-dimensional echocardiogram were determined before and after treatments.
  
  
  RESULTS
  Both sitagliptin and NPH therapies decreased HbA1c levels after 24 weeks. Fasting plasma glucose and triglyceride levels decreased in the NPH group whereas only sitagliptin increased aGLP-1 levels. Left ventricular diastolic dysfunction (LVDD) was detected in 58.6% of twenty-nine patients evaluated. Beneficial effects in LVDD were observed in 75% and 11% of patients treated with sitagliptin and NPH, respectively (p = 0.015). Neither therapy changed C-reactive protein or blood pressure.
  
  
  CONCLUSIONS
  Sitagliptin and bedtime NPH were similarly effective on glucose control. Improvement in LVDD in T2DM patients treated with sitagliptin was suggested, probably related to the increase of aGLP-1 levels. Therefore, DPP-4 inhibitor seems to have cardioprotective effects independent of glucose control and may have a role in the prevention of diabetic cardiomyopathy.
authors.affiliation: Laboratório de Carboidratos e Radioimunensaio LIM-18 do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 455 sala 3324, Sao Paulo, SP Brazil.
authors.forename: Katia Camarano
authors.initials: KC
authors.lastname: Nogueira
authors.affiliation: Serviço de Ecocardiografia do Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Meive
authors.initials: M
authors.lastname: Furtado
authors.affiliation: Laboratório de Carboidratos e Radioimunensaio LIM-18 do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 455 sala 3324, Sao Paulo, SP Brazil.
authors.forename: Rosa Tsuneshiro
authors.initials: RT
authors.lastname: Fukui
authors.affiliation: Laboratório de Carboidratos e Radioimunensaio LIM-18 do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 455 sala 3324, Sao Paulo, SP Brazil.
authors.forename: Marcia Regina Silva
authors.initials: MR
authors.lastname: Correia
authors.affiliation: Laboratório de Carboidratos e Radioimunensaio LIM-18 do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 455 sala 3324, Sao Paulo, SP Brazil.
authors.forename: Rosa Ferreira
authors.initials: RF
authors.lastname: Dos Santos
authors.affiliation: Serviço de Ecocardiografia do Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: José Lázaro
authors.initials: JL
authors.lastname: Andrade
authors.affiliation: Laboratório de Carboidratos e Radioimunensaio LIM-18 do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 455 sala 3324, Sao Paulo, SP Brazil.
authors.forename: Maria Elizabeth
authors.initials: ME
authors.lastname: Rossi da Silva
keywords: Bedtime NPH insulin; Cardiovascular function; Dypeptidil-peptidase-4 inhibitor; Glucagon-like peptide 1; Type 2 diabetes mellitus (T2DM)