Effects Of Empagliflozin On Carotid Intima-media Thickness And Serum High-sensitivity C-reactive Protein In Patients With Type 2 Diabetes Mellitus

Objective:The results of the EMPA-REG study confirmed that empagliflozin can bring definite cardiovascular benefits for patients with type2 diabetes mellitus(T2DM)combined with cardiovascular disease,but the specific mechanism is not yet very clear.In this study,T2DM patients treated with empagliflozin or DPP4 inhibitors(DPP4i)were selected through 1:1propensity score matching,and their clinical data were retrospectively analyzed to compare the effects of empagliflozin or DPP4 inhibitor treatment on serum inflammatory factor high-sensitivity C-reactive protein(hs CRP)levels and carotid intima-media thickness(CIMT),and explore the effects and possible mechanisms of empagliflozin in improving atherosclerosis.Methods:A retrospective analysis of the clinical data of T2DM patients in the outpatient and inpatient department of the endocrinology department of the Second Hospital of Hebei Medical University from December 2019 to December 2020.T2DM patients who were treated with empagliflozin or DPP4inhibitors for 12 weeks were selected through 1:1 propensity score matching,and they were divided into empagliflozin group and DPP4 inhibitor group,including 21,respectively.The patients were given empagliflozin 10 mg 1/d±other hypoglycemic drugs(except for GLP-1 receptor agonists and DPP4inhibitors)in empagliflozin group;The patients were given DPP4 inhibitors±other hypoglycemic drugs(except GLP-1 receptor agonists and SGLT2i)in DPP4 inhibitor group;other hypoglycemic drugs and combination drugs for basic diseases used in the two groups were matched by propensity scores.Then,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),glycosylated hemoglobin(Hb Alc),cholesterol(TC),triglyceride(TG),low Density lipoprotein(LDL-C),high density lipoprotein(HDL-C),blood uric acid(UA),renal function index(Scr,BUN),high-sensitivity C-reactive protein(hs CRP)and carotid artery intima-media thickness(CIMT)were measured,and the changes of each index after treatment compared with the baseline between the two groups were observed.Normally distributed data were expressed as mean±standard deviation((?)±s),and t test was used intra-group and between-group;non-normally distributed measurement data were expressed by median and interquartile range[M(Q_L,Q_U)],and rank sum test was used for comparison between groups.Results:1.The basic features of the patients at baseline:After the two groups of patients were matched by the application of the propensity score,a total of 21pairs of patients were successfully matched.There were no significant differences between the two groups in confounding variables such as gender,age,course of diabetes,BMI,Hb Alc,combined medication,and previous comorbidities(P>0.05);2.Changes in glucose and lipid metabolism,uric acid and renal function indexes after treatment:After 12 week treatment,FBG,Hb Alc,TG,LDL-C and UA in two groups were significantly reduced compared with baseline(P<0.01).The greater reduction in Hb Alc and UA was showed in empagliflozin group(P<0.05).The TC of the DPP4i group was significantly lower than that at baseline(P<0.01).While,there was no significant change in TC in empagliflozin group from baseline(P>0.05).Compared with baseline,HDL-C and renal function indexes showed no significant difference(P>0.05);3.Changes in blood pressure and BMI after treatment:After 12 week treatment,SBP and DBP in the two groups were significantly lower than those at baseline(P<0.01,P<0.05).The BMI of the empagliflozin group was also significantly lower than that at baseline(P<0.01).There was no significant change in BMI in DPP4i group from baseline(P>0.05).The greater reduction in SBP and BMI was showed in empagliflozin group(P<0.01,P<0.05);4.Changes in hs CRP and CIMT after treatment:After 12 week treatment,the levels of hs CRP in the two groups were significantly lower than that at baseline(P<0.01);CIMT in empagliflozin group was significantly lower than that at baseline(P<0.01),while,there was no significant change in CIMT from baseline in DPP4i group(P>0.05).After treatment,the greater reduction in hs CRP and CIMT was showed in empagliflozin group(P<0.01).Conclusions:1.Empagliflozin could improve glucose and lipid metabolism,lose weight,lower blood pressure and uric acid levels in T2DM patients.2.Empagliflozin could reduce the levels of the inflammatory factor hs CRP,which delayed the progression of carotid atherosclerosis.