Lipid metabolism features in patients with type 2 diabetes on combination therapy with empagliflozin compared with metformin monotherapy

• Alina P. Misharova
• Alexander S. Ametov
• Larisa V. Kondratyeva
• Tatyana N. Korotkova

Abstract

Today, there is still a high mortality rate in patients with type 2 diabetes mellitus (T2DM). However, the treatment paradigm for T2DM has changed with the discovery of a new class of drugs, sodium-glucose cotransporter type 2 inhibitor, which showed a decrease in mortality from cardiovascular diseases when taking empagliflozin. In this connection, it has been suggested that there is a different mechanism of action of gliflozins in relation to metabolic health parameters in patients with T2DM.

Purpose of the study: to study effects of empagliflozin on fat metabolism in patients with T2DM.

Design. Single center prospective randomized study.

Material and methods. The study included 63 patients (49 of them women) with T2DM and obesity. The average age of the patients was 61.5 years. After randomization using the random number method, patients were recommended treatment: in group 1 (n=38) metformin 2000 mg per day + empagliflozin 25 mg per day, in group 2 (n=25) monotherapy metformin 2000 mg/day. Dynamics of such parameters as body weight (BW), height, waist circumference (WC) and hip circumference (HC), body mass index (BMI), fasting blood glucose level, glycated hemoglobin, lipid profile parameters, adiponectin, index HOMA-IR (Homeostasis model assessment of insulin resistance) was assessed at 3 and 6 months.

Results. In the combination therapy group, along with a statistically significant antihyperglycemic effect, we found reliable results on the effect of empagliflozin on fat metabolism, namely, a decrease in BW (p=0.028), BMI (p=0.033), WC (p=0.017) after 6 months of observation. The data obtained are consistent with the positive statistically significant dynamics of improvement in insulin sensitivity (p=0.029) and an increase in the level of adiponectin from 9.47 to 14.4 μg/ml (p=0.031) after 6 months. Also, against the background of an increase in the level of adiponectin, a decrease in the level of total cholesterol, low-density lipoprotein cholesterol, triglycerides and an increase in the level of high density lipoprotein cholesterol was noted, which was confirmed by correlation analysis.

Conclusion. The results of our study confirm the important nonglycemic effects of empagliflozin on fat metabolism in patients with T2DM.

Keywords:type 2 diabetes mellitus; obesity; fat metabolism; empagliflozin

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