Cardiometabolic Effects of Empagliflozin in Patients Undergoing Elective Percu-taneous Coronary Intervention for Type 2 Diabetes Mellitus

Aim      To evaluate cardiometabolic effects of empagliflozin in patients with ischemic heart disease and type 2 diabetes mellitus (DM) following elective percutaneous coronary intervention (PCI).Materials and methods Patients meeting the inclusion/non-inclusion criteria were randomized into two groups of equal number using simple randomization with successively assigned numbers. Group 1 included 37 patients (18 men and 19 women) who gave their consent for the treatment with empagliflozin 10 mg/day in addition to their previous hypoglycemic therapy. The drug administration started one month prior to the elective PCI and continued for the next 11 months (treatment duration, 12 months). Group 2 (comparison group) consisted of age- and DM duration-matched patients (37 patients; 18 men and 19 women) who continued on their hypoglycemic therapy previously prescribed by endocrinologists during the entire study period. Before the study, 36.11 % patients of the empagliflozin group and 27.03 % of the comparison group had unsatisfactory glycemic control as shown by the level of glycated hemoglobin (HbA1c).Results At 6 and 12 months of the study, fasting glycemia and HbA1c were significantly lower in the empagliflozin treatment group. The groups were comparable by the incidence of adverse outcomes: 8 (22.24 %) patients in the empagliflozin group and 10 (27.04 %) patients in the comparison group (р=0.787). The 12-month empagliflozin treatment reduced total cholesterol (C) by 5.56 % (p<0.05), low density lipoprotein (LDL) C by 3.67 % (p<0.05), visceral adipose tissue area (VATA) by 5.83 % (p<0.05), and subcutaneous adipose tissue area (SATA) by 3.54 % (p<0.05).Conclusion      The empagliflozin treatment for 30 days prior to and after elective PCI can enhance the effectiveness of myocardial revascularization due to the demonstrated beneficial cardiometabolic effects.

Visceral Obesity: Terminology, Measurement, and Its Correlation with Inflammation

The prevalence of childhood obesity in the world is significant and it is topical issue due to the high risk of chronic non-communicable diseases development. This article presents the analysis of pathogenetic role of visceral obesity, describes modern methods for measuring visceral adipose tissue, discusses major terminology on obesity. The current data on inflammation induced by excess of visceral adipose tissue and inflammasome’s role in this process are summed up. All the findings are crucial for the development of tools for prevention any obesity associated adverse effects in children.

[Obesity without diabetes: the role of hormonal regulation]

AIM

Obese patients without diabetes present an interesting phenotype to explore protective mechanisms against type 2 diabetes (T2D) development. In our study we looked for specific hormonal features of obese patients without T2D.

MATERIALS AND METHODS

We included 6 groups of patients with different metabolic profiles (n=212): controls with BMI25 kg/m2, HbA1c6%, age 30 years; patients with 25BMI30 kg/m2and HbA1c6%; patients with 25BMI30 kg/m2and HbA1c6%; patients with BMI30 kg/m2and HbA1c6% (+ Obesity - T2D) obese patients without T2D or prediabetes; patients with BMI30 kg/m2and newly-diagnosed T2D/prediabetes, HbA1c6%; patients with known history of T2D on glucose-lowering drugs with BMI30 kg/m2. Insulin, GLP-1, GIP were measured during glucose-tolerance test at 0, 30 and 120 minutes; insulin resistance (IR) was assessed by HOMA-IR.

RESULTS

Waist circumference was bigger in patients with obesity despite their metabolic profile comparing to patients without obesity (p0.001). Waist-to-hip ratio was similar in patients with different metabolic status. According to IR + Obesity - T2D group had intermediate position: IR was higher in that group comparing to people without obesity, but was less that in patients with obesity and HbA1c6% (p0.001). + Obesity - T2D group had the most potent baseline insulin secretion, assessed by НОМА-%band the highest postprandial secretion, measured by insulinogenic index among all patient groups with obesity (p0.001). There was no significant difference in GLP-1 secretion; GIP secretion was higher in patients with BMI30 kg/m2comparing to people with BMI30 kg/m2(p0.01).

Visceral adiposity index in patients with coronary artery disease, obesity and type 2 diabetes

Aim. To assess visceral adiposity index (VAI) in patients with coronary artery disease (CAD) and overweight or obesity, as well as to determine its relationship with lipid and carbohydrate metabolism parameters and inflammatory markers, depending on the presence of carbohydrate metabolism disorders (CMD).

Material and methods. The study included 95 patients with CAD and overweight (body mass index (BMI) >25 kg/m2) or obesity (BMI >30 kg/m2), of which 59 patients had type 2 diabetes (T2D) and 36 were without CMD. All patients were assessed for obesity; VAI was calculated. Following laboratory parameters were evaluated: glucose, glycated hemoglobin, C-reactive protein, adiponectin, lipid panel. In patients without history of CMD, an oral glucose tolerance test was performed.

Results. Compared with patients without CMD, subjects with T2D had significantly higher values of BMI, waist circumference, as well as the body fat percentage, area and volume of visceral adipose tissue estimated by computed tomography. Analysis of lipid profile, C-reactive protein and adiponectin levels did not reveal significant differences between the groups. VAI also did not significantly differ in both groups. VAI had the most correlations with clinical and metabolic parameters in both patients with T2D and without CMD. Other methods for assessing obesity were less correlated with laboratory parameters in both groups. Only VAI significantly correlated with adiponectin in both groups.

Conclusion. The obtained correlations between VAI and clinical and metabolic parameters confirm the practicability of using it to determine adipose tissue dysfunction in patients with/without CMD. The effect of increased VAI on the cardiovascular risk in high-risk patients requires further study.