Poster Session Saturday 14 December - AM: 14/12/2013, 08:30-12:30 * Location: Poster area

Abstract

Introduction: DiabetesMellitus (DM)successfulmanagement is determined by the achievement of normal blood glucose levels as well as the prevention of micro and macro vascular complications. Left ventricular diastolic dysfunction (LVDD) is a usual sign of diabetic cardiomyopathy even in asymptomatic patients.Different indices are used to assess LVDD; transmitral flow, tissue Doppler and left atrial volume index are some of them. On the other hand, different anti‐hyperglycemic agents are used to achieve normal blood glucose levels. Methods: We compared the effects of the dipeptidil‐peptidase‐4 (DPP‐4) sitagliptin with insulin glargine on the LVDDofDMtype 2 patients inadequately controlledwith metformin and the sulfonylurea glimepiride. Fifty four patients with similar age, diabetes duration, normotensive, non significant coronary artery disease as excluded by exercise tolerance test and HbA1c were randomized to receive sitagliptin (SITA group, n=28) or insulin glargine (INSgroup,n=26)as additional treatment for36 weeks.Acomprehensive echostudy was performed at the beginning and at the end of the follow up by the same echocardiographer using transmitral flow, tissue Doppler and left atrial volume index (LAVI) as indices for determination of diastolic function. All the subjects had normal ejection fraction. Results: Glucose control as determined by HbA1c showed that the two agents had the same impact on HbA1c. (SITA HbA1c 8.1 +/‐0.7 to 7.3+/‐0.8% and INS HbA1c 8.0 +/‐0.6 to 7.3+/‐ 0.7). The SITA group revealed greater improvement in the diastolic function that the INS group (39% vs 15%). 11 out of 28 patients in the SITA group had a degree of improvement of the diastolic function while for 4 out of 26 this occurred in the INS group. This improvement was also seen in terms of the LAVI, since in the SITA group the preprotocol index was 25.1 +/‐6 while the post protocol values went to 23.0 +/‐ 5 and in the INS group form 25.0 +/‐6 to 23.9 +/‐6. Conclusions:Sitagliptin and insulin glargine were equal in lowering the glucose levels. However, there has been a significant improvement of diastolic function in the SITA group compared to the INS group, as measured by E/E' and LAVI. The reason for that could be the fact that the increase of GLP‐1 levels may lead to a beneficial effect on cardiovascular system as this is implied by a number of studies. Therefore, sitagliptin may be a promising agent for the management of diabetic cardiomyopathy (Table presented).