The role of empagliflozin-induced metabolic changes for cardiac function in patients with type 2 diabetes. A randomized cross-over magnetic resonance imaging study with insulin as comparator
Authors' conclusion
Despite significant metabolic differences, cardiac function did not differ on empagliflozin compared with insulin treatment. Impaired cardiac function during acipimox treatment, could suggest greater cardiac reliance on lipid metabolism for proper function during empagliflozin treatment in patients with type 2 diabetes.
Study context
- Population
- Patients with T2D, BMI > 28 kg/m², C-peptide > 500 pMcross-over
- Participants
- 17 patients
- Comparison
- Empagliflozin vs insulin
- Primary endpoint
- Cardiac diastolic function on MRI: left ventricle early peak-filling rate
- Follow-up
- End of 5-week treatments
Methodological detailscross-over, 3-week washouts, insulin titrated to same glycaemic control
- Cross-over
- 3-week washouts
- Insulin titrated to same glycaemic control
Primary result
As reported in the abstract
Cardiac diastolic function (LV early peak-filling rate) · end of treatment
- Cardiac diastolic function unchanged by either treatment
Secondary outcomes
| Outcome | Estimate | P value |
|---|---|---|
| Diastolic function after acipimox under chronotropic stressMean ± SE | ΔT: E-I −51 ml/s | P < 0.05 |
| Systolic function after acipimox under chronotropic stress± 1 (SE); ΔE: −3 ± 1% (p < 0.05); ΔI: 1 ± 2 (ns, ns vs ΔE) · Mean ± SE | ΔT: E-I −3 % | P < 0.05 |
- Diastolic function after acipimox under chronotropic stress — Acipimox decreased fatty acids
- 35%
- Diastolic function after acipimox under chronotropic stress: ± 22 (SE); ΔE: −33 ± 26 ml/s (ns); ΔI: 37 ± 26 (ns, p < 0.05 vs ΔE)
Systolic function (LV ejection fraction)
- Cardiac systolic function unchanged by either treatment
Metabolic changes
- Glucose similar; fatty acids, ketone bodies and lipid oxidation increased, insulin decreased on E vs I
Original publication
The role of empagliflozin-induced metabolic changes for cardiac function in patients with type 2 diabetes. A randomized cross-over magnetic resonance imaging study with insulin as comparator. Cardiovasc Diabetol. Published 6 January 2024. doi:10.
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