The EMPA-REG Outcome trial empa, a SGLT2-inhibitor, showed in Sept 2015 great cardiovascular benefits. Changes in energy metabolism could explain how SGLT2 inhibition improves cardiovascular outcomes, according to prof Ferrannini, Pisa, Italy.

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"Empa improves the working efficiency of the heart by changing preferred substrate and increasing hematocrit", he said at the meeting yesterady. All the papers presented at the session will appear in the July issue of Diabetes Care.

Empa reduces glucose and increases ketonemia, particularly beta-hydroxybuturate (beta-HB). The heart can utilize any energy substrate, but beta-HB can be utilized more efficiently than lipid or carbohydrate substrates and significantly improves cardiac efficieny.

The same combination of improved energy efficiently and increased hemotocrit could also account for the improved renal function set in the EMPA trial, said prof Sunder Mudaliar, San Diego, USA. SGLT2 inhibition not only reduces hyperglycemia as a contributing factor to kidney disease, but also improves the energy efficiently of the kidney by increasing beta-HB. Improving hematocrit helps reduce the chronic hypoxia that contributes to kidney disease.

Long-awaited data on EMPA was also presented, around 50% reduction in nephropathy, less kidney failure, dialysis and transplantation.