Vildagliptin in addition to metformin improves retinal blood flow and erythrocyte deformability in patients with type 2 diabetes mellitus - results from an exploratory study

Abstract

Numerous rheological and microvascular alterations characterize the vascular pathology in patients with type 2 diabetes mellitus (T2DM). This study investigated effects of vildagliptin in comparison to glimepiride on retinal microvascular blood flow and erythrocyte deformability in T2DM.Fourty-four patients with T2DM on metformin monotherapy were included in this randomized, exploratory study over 24 weeks. Patients were randomized to receive either vildagliptin (50 mg twice daily) or glimepiride individually titrated up to 4 mg in addition to ongoing metformin treatment. Retinal microvascular blood flow (RBF)and the arteriolar wall to lumen ratio (WLR) were assessed using a laser doppler scanner. In addition, the rythrocyte elongation index (EI) was measured at different shear stresses using laserdiffractoscopy.Both treatments improved glycaemic control (p < 0.05 vs. baseline; respectively). While only slight changes in RBF and the WLR could be observed during treatment with glimepiride, vildagliptin significantly increased retinal bloodflow and decreased the arterial WLR (p < 0.05 vs. baseline respectively). The EI increased during both treatments over a wide range of applied shear stresses (p < 0.05 vs. baseline). An inverse correlation could be observed between improved glycaemic control (HbA1c) and EI (r = -0.524; p < 0.0001) but not with the changes in retinal microvascular measurements.Our results suggest that vildagliptin might exert beneficial effects on retinal microvascular blood flow beyond glucose control. In contrast, the improvement in erythrocyte deformability observed in both treatment groups,seems to be a correlate of improved glycaemic control.

Figure 1

Mean change from baseline in retinal blood flow (RBF) during glimepiride and vildagliptin treatment after 12 and 24 weeks of treatment (□ = glimepiride; ■ = vildagliptin; mean ± SEM; * = p < 0.05 vs. baseline).

Figure 2

Mean change from baseline in retinal arteriolar wall to lumen ratio (WLR) during glimepiride and vildagliptin treatment after 12 and 24 weeks of treatment (□ = glimepiride; ■ = vildagliptin; mean ± SEM; * = p < 0.05 vs. baseline).