Background: Left ventricular (LV) diastolic dysfunction is frequently observed in patients with type 2 diabetes.\nDipeptidyl peptidase-4 inhibitor (DPP-4i) attenuates postprandial hyperglycemia (PPH) and may have cardio-protective\neffects. It remains unclear whether DPP-4i improves LV diastolic function in patients with type 2 diabetes, and, if so, it is\nattributable to the attenuation of PPH or to a direct cardiac effect of DPP-4i. We compared the effects of the DPP-4i,\nsitagliptin, and the alpha-glucosidase inhibitor, voglibose, on LV diastolic function in patients with type 2 diabetes.\nMethods: We conducted a prospective, randomized, open-label, multicenter study of 100 diabetic patients with LV\ndiastolic dysfunction. Patients received sitagliptin (50 mg/day) or voglibose (0.6 mg/day). The primary endpoints were\nchanges in the eâ�� velocity and E/eâ�� ratio from baseline to 24 weeks later. The secondary efficacy measures included\nHbA1c, GLP-1, lipid profiles, oxidative stress markers and inflammatory markers.\nResults: The study was completed with 40 patients in the sitagliptin group and 40 patients in the voglibose group.\nThere were no significant changes in the eâ�� velocity and E/eâ�� ratio from baseline to 24 weeks later in both groups.\nHowever, analysis of covariance demonstrated that pioglitazone use is an independent factor associated with changes\nin the eâ�� and E/eâ�� ratio. Among patients not using pioglitazone, eâ�� increased and the E/eâ�� ratio decreased in both the\nsitagliptin and voglibose groups. GLP-1 level increased from baseline to 24 weeks later only in the sitagliptin group\n(4.8 �± 4.7 vs. 7.3 �± 5.5 pmol/L, p < 0.05). The reductions in HbA1c and body weight were significantly greater in the\nsitagliptin group than in the voglibose group (?0.7 �± 0.6 % vs. ?0.3 �± 0.4, p < 0.005; ?1.3 �± 3.2 kg vs. 0.4 �± 2.8 kg,\np < 0.05, respectively). There were no changes in lipid profiles and inflammatory markers in both groups.\nConclusions: Our trial showed that sitagliptin reduces HbA1c levels more greatly than voglibose does, but that neither\nwas associated with improvement in the echocardiographic parameters of LV diastolic function in patients with\ndiabetes.
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