Effect of Empagliflozin on Whole Body, Cardiac, and Renal Sympathetic Outflows in Type 2 Diabetes
Abstract
Background: Sodium glucose co-transporter type 2 inhibitors improve cardiovascular outcomes in people with type 2 diabetes, though mechanisms by which this occurs remain unclear.
Objectives: The purpose of this study was to evaluate empagliflozin's effect on whole body, cardiac, and renal sympathetic activity in people with type 2 diabetes and cardiovascular disease or high cardiovascular risk.
Methods: Adults with type 2 diabetes, randomized to 25 mg/day empagliflozin or placebo for 12 weeks, had norepinephrine (NE) spillover kinetics assessed during right heart catheterization. Endpoints were mean spillover rates at the end of treatment, adjusted for baseline (primary outcome whole-body spillover; secondary outcomes cardiac and renal spillovers).
Results: Of 15 participants randomized to empagliflozin (15 completed treatment) and 17 to placebo (16 completed treatment), most were Caucasian males, mean age 67.9 years, glycated hemoglobin 8.0%, and body mass index 31.1 kg/m2. Baseline NE spillover rates did not differ between the 2 groups. Twelve weeks of empagliflozin treatment did not significantly alter whole body, cardiac, or renal NE spillover rates compared to placebo (P > 0.30 for all comparisons). Empagliflozin significantly lowered pulmonary capillary wedge pressure (adjusted between-group difference: -1.8 mm Hg; 95% CI: -3.4 to -0.1), and glycated hemoglobin (-0.3%; 95% CI: -0.6 to -0.02), with trends toward lower diastolic blood pressure (-3.9 mm Hg; 95% CI: -7.7…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 15 participants or records.
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