Combination Therapies for Vascular Function in Diabetes Patients

A prospective, randomized trial evaluated the efficacy of two different combination therapies on vascular function in patients with type 2 diabetes. Patients were randomized to either once daily combination empagliflozin (E) 10 mg with linagliptin (L) 5 mg once daily or metformin (M) 850 mg or 1000 mg twice daily with insulin (I). Baseline and 12-week evaluations included peripheral office and 24-hour ambulatory blood pressure measurement, as well as vascular assessment via pulse wave analysis under office and ambulatory conditions. After 12 weeks of E+L treatment, office, 24-hour ambulatory, central blood pressure, and pulse pressure decreased; no change presented in 12-week M+I treatment. The study authors observed greater decreases in the E+L group compared with the M+I group in 24-hour ambulatory peripheral systolic (between-group difference, –5.2 ± 1.5 mmHg; P=0.004), diastolic blood pressure (–1.9 ± 1.0 mmHg; P=0.036), and pulse pressure (–3.3 ± 1.0 mmHg; P=0.007). The E+L group had significantly greater decreases in central office systolic blood pressure (–5.56 ± 1.9 mmHg; P=0.009), forward pressure height of the pulse wave (–2.0 ± 0. 9 mmHg; P=0.028), 24-hour ambulatory central systolic (–3.6 ± 1.4 mmHg; P=0.045), diastolic blood pressure (–1.95 ± 1.1 mmHg; P=0.041), and 24-hour pulse wave velocity (–0.14 ± 0.05 m/s; P=0.043).