The purpose of the EmDia trial is to compare the effects of empagliflozin with placebo in addition to standard diabetic treatment or dietetic treatment on cardiac diastolic function in patients with type 2 Diabetes mellitus.
Diabetes is a serious and increasing global health burden. It has been shown, that diabetes is associated with a two-fold higher risk for coronary heart disease, stroke and for the aggregate of other vascular death independently of other conventional risk factors. It is the leading cause of cardiovascular disease. Diabetes mellitus substantially increases the risk of macrovascular and microvascular complications, such as vascular dysfunction with developing coronary, cerebrovascular, and peripheral arterial disease, heart failure, nerve disorders (neuropathy), eye complications (e.g. cataracts, glaucoma diabetic retinopathy), kidney disease (nephropathy), foot ulcers, restriction of mental function, and psychosomatic diseases (e.g. stress, anxiety and depression). The most common of the cardiovascular complications in diabetics are ischemic cardiomyopathy and left ventricular (LV) dysfunction. Of particular interest here is the diastolic dysfunction, as an early sign of diabetic heart muscle disease followed by systolic damage. Although diabetes has a decisive role in the development of cardiovascular disease, traditional glucose lowering agents have failed to convincingly show that intensive glucose control significantly reduces CVD events. A new approach for treatment of adult patients with type 2 diabetes was found with the selective inhibition of sodium glucose cotransporter 2 (SGLT2). Studies have shown that empagliflozin, a potent SGLT2 inhibitor, not only effectively reduces the rates of hyperglycemia but also blood pressure and weight. (16, 18) In addition, beneficial effects on arterial stiffness and vascular resistance, visceral adiposity, albuminuria and plasma urate have been reported. The results of the EMPA-REG OUTCOME study suggest that empagliflozin added to the standard therapy has a positive influence on cardiovascular outcomes and heart failure hospitalization in individuals with diabetic mellitus. The aim of the present study is to investigate the effects of empagliflozin, in comparison with placebo, on cardiac and vascular function as well as on cardiac biomarker in individuals with type 2 diabetes with standard therapy, increased E/E' ratio and poor glycemic control.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
144
10 mg per os daily for 12 weeks
amount of Placebo corresponding to empagliflozin 10 mg per os daily for 12 weeks
Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Zentrum für Kardiologie, Präventive Kardiologie und Medizinische Prävention
Mainz, Germany
difference in E/E' ratio between 12 weeks after baseline and at baseline
difference in E/E' ratio (noninvasive surrogate marker for left ventricular diastolic function (LVEDP) measured by 2D-echocardiography) between 12 weeks after baseline and at baseline
Time frame: 12 weeks
difference in E/E' ratio (change from baseline (V1) to 1 week follow-up)
difference in E/E' ratio (change from baseline (V1) to 1 week follow-up (2D-echocardiography)
Time frame: 1 week
difference in Left ventricular systolic function (LVEF)
difference in Left ventricular systolic function (LVEF) from baseline to week 1
Time frame: 1 week
difference in Left ventricular systolic function (LVEF)
difference in Left ventricular systolic function (LVEF) from baseline to week 12
Time frame: 12 weeks
difference in Left end-diastolic volume (LEDV)
difference in Left end-diastolic volume (LEDV) from baseline to week 1
Time frame: 1 week
difference in Left end-diastolic volume (LEDV)
difference in Left end-diastolic volume (LEDV) from baseline to week 12
Time frame: 12 weeks
difference in Carotid-femoral pulse wave velocity
difference in Carotid-femoral pulse wave velocity (cf-PWV, vascular explorer - calculated) from baseline to week 1
Time frame: 1 week
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difference in Carotid-femoral pulse wave velocity
difference in Carotid-femoral pulse wave velocity (cf-PWV, vascular explorer - calculated) from baseline to week 12
Time frame: 12 weeks
difference in Augmentation index (AIx)
difference in Augmentation index (AIx, vascular explorer) from baseline to week 1
Time frame: 1 week
difference in Augmentation index (AIx)
difference in Augmentation index (AIx, vascular explorer) from baseline to week 12
Time frame: 12 week
difference in Arterial stiffness index (SI)
difference in Arterial stiffness index (SI, photo plethysmography) from baseline to week 1
Time frame: 1 week
difference in Arterial stiffness index (SI)
difference in Arterial stiffness index (SI, photo plethysmography) from baseline to week 12
Time frame: 12 weeks
difference in Reflection index
difference in Reflection index (photo plethysmography) from baseline to week 1
Time frame: 1 week
difference in Reflection index
difference in Reflection index (photo plethysmography) from baseline to week 12
Time frame: 12 weeks
difference in Brain natriuretic peptide (BNP)
difference in Brain natriuretic peptide (BNP) from baseline to week 1
Time frame: 1 week
difference in Brain natriuretic peptide (BNP)
difference in Brain natriuretic peptide (BNP) from baseline to week 12
Time frame: 12 weeks
difference in High sensitive troponin I (hs TnI)
difference in High sensitive troponin I (hs TnI) from baseline to week 1
Time frame: 1 week
difference in High sensitive troponin I (hs TnI)
difference in High sensitive troponin I (hs TnI) from baseline to week 12
Time frame: 12 weeks
difference in High sensitive C-reactive protein (hs CRP)
difference in High sensitive C-reactive protein (hs CRP) from baseline to week 1
Time frame: 1 week
difference in High sensitive C-reactive protein (hs CRP)
difference in High sensitive C-reactive protein (hs CRP) from baseline to week 12
Time frame: 12 weeks
difference in E/E' ratio (change from baseline (V1) to 12 weeks follow-up) in the subgroup of patients with eGFR 45-59 ml/min/1.73 m²
difference in E/E' ratio (noninvasive surrogate marker for left ventricular diastolic function (LVEDP) measured by 2D-echocardiography) between 12 weeks after baseline and at baseline in the subgroup of patients with eGFR 45-59 ml/min/1.73 m²
Time frame: 12 weeks
difference in E/E' ratio (change from baseline (V1) to 12 weeks follow-up) in the subgroup of patients with HbA1c 6.5%-6.9%
difference in E/E' ratio (noninvasive surrogate marker for left ventricular diastolic function (LVEDP) measured by 2D-echocardiography) between 12 weeks after baseline and at baseline in the subgroup of patients with with HbA1c 6.5%-6.9%
Time frame: 12 weeks