Effects of baricitinib, empagliflozin, linagliptin and telmisartan on cardiovascular autonomic neuropathy in type 1 diabetes: An exploratory, randomized, open‐label, crossover trial
Abstract
Cardiovascular autonomic neuropathy (CAN) is a prevalent complication in type 1 diabetes and a risk factor for cardiovascular mortality. CAN is preventable to some extent: Intensive glucose control demonstrated a 45% risk reduction of CAN in persons with type 1 diabetes in the Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC). To our knowledge, however, no treatment is available when CAN is incident. In the search for new interventions, we tested the effects of treatment for 4 weeks with four drugs (baricitinib, empagliflozin, linagliptin and telmisartan) on measures of CAN in persons with type 1 diabetes. The main hypothesis was that one or more of these drugs, with known beneficial effects on microvascular complications (albuminuria), could also improve autonomic function measures. Additionally, we hypothesized that there would be heterogeneity in drug efficacy, as seen for albuminuria, and aimed to determine whether the outcomes could be improved using an individual bestdrug-response approach.
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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