Empagliflozin Improves Vascular Insulin Sensitivity and Muscle Perfusion in Persons with Type 2 Diabetes

Am J Physiol Endocrinol Metab. 2024 Jan 3. doi: 10.1152/ajpendo.00267.2023. Online ahead of print.ABSTRACTSodium glucose cotransporter 2 inhibitors (SGLT2is) improved MACE, heart failure and renal outcomes in large trials; however, a thorough understanding of the vascular physiologic changes contributing to these responses is lacking. We hypothesized that SGLT2i therapy would diminish vascular insulin resistance and improve hemodynamic function, which could improve clinical outcomes. To test this, we treated 11 persons with type 2 diabetes for 12 weeks with empagliflozin 10 mg/d and measured vascular stiffness, endothelial function, peripheral and central arterial pressures, skeletal and cardiac muscle perfusion, and vascular biomarkers before and at 120 minutes of a euglycemic hyperinsulinemic clamp at weeks 0 and 12. We found that prior to empagliflozin treatment, insulin infusion lowered peripheral and central aortic systolic pressure (p<0.05) but was without effect on other vascular measures. Following empagliflozin, insulin infusion improved endothelial function (p=0.02), lowered peripheral and aortic systolic (each p<0.01), diastolic (each p<0.05), mean arterial (each p<0.01), and pulse pressures (each p<0.02), altered endothelial biomarker expression, and decreased radial artery forward and backward pressure amplitude (each p=0.02). Empagliflozin also improved insulin-mediated skeletal and cardiac muscle microvascular perfusion (each p<0.05). We concl...
Source: Am J Physiol Endocri... - Category: Endocrinology Authors: Source Type: research