One of the biggest problems that come alongside diabetes is the increased risk of cardiovascular disease. Treatment of diabetes often reduces the risk, but some scientists wonder if the treatments reduce the risk by treating diabetes or directly affecting the cardiovascular system.
One of the go-to treatments for type 2 diabetes is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. This protein is a regulator of sugar in the blood, and its inhibition can increase the amount of sugar excreted by the bladder. Dapagliflozin, empagliflozin, and canagliflozin are all drugs that use this mechanism to control sugar levels in diabetic patients. Still, some recent evidence suggests these may also independently reduce the risk of cardiovascular disease.
In a new study, a team from the University Medical Center Hamburg-Eppendorf in Germany wanted to investigate further. A few recent studies have shown that SGLT2 inhibitors lowered the risk of cardiovascular hospitalization or death in patients with diabetes. However, these studies were conducted in the absence of insulin, a common diabetes treatment. This new study investigated whether the reduced cardiovascular risk could also be seen in patients treated with insulin.
To do this, the team examined the cardiovascular biomarkers hematocrit, red blood cell count, and reticulocyte in a double-blind, randomized trial. All are indicators of cardiovascular risk. Enrolled patients were being treated with insulin and were put in either a placebo group or given a certain dose of the SGLT2 inhibitor dapagliflozin.
The study found that dapagliflozin treatment increased both hematocrit levels in the blood and red blood cell count across the 104-week trial. Reticulocytes, a precursor to red blood cells, increased during the first 4-weeks but then dropped back down to levels akin to the placebo group. These results suggest that SGLT2 inhibitors have the same effect against cardiovascular risk in diabetic patients treated with insulin as they do with patients not being treated with insulin.
This study followed markers of cardiovascular risk during dapagliflozin treatment in a group of diabetic patients already being treated with insulin. They did not independently measure the onset of cardiovascular disease in their study, however previous studies had found that the increases to hematocrit, red blood cell count, and reticulocytes correlate well with a reduced cardiovascular risk in diabetic patients.
The study concludes, “In summary, we show that dapagliflozin induces a long-term and dose-dependent elevation in haematocrit that is preserved in patients receiving concomitant insulin treatment, including chronic insulin therapy.”