Skip to main content
Top
Published in: Acta Diabetologica 4/2024

20-12-2023 | Empagliflozin | Original Article

Assessing early tubular protective effects of SGLT2 inhibitor empagliflozin against type 2 diabetes mellitus using functional magnetic resonance imaging

Authors: Chuangbiao Zhang, Beibei Zhu, Youzhen Feng, Zhongyuan Cheng, Xiangran Cai, Lie Feng, Jiaying Li, Xiaohua Lu

Published in: Acta Diabetologica | Issue 4/2024

Login to get access

Abstract

Aims

To observe the alterations in functional magnetic resonance imaging parameters in normoalbuminuric type 2 diabetic patients undergoing SGLT2 inhibitor empagliflozin treatment and investigate the early tubular protective effects of the inhibitor.

Methods

This study was performed in normoalbuminuric type 2 diabetes mellitus patients (UACR < 30 mg/g, eGFR ≥ 60 ml/min/1.73 m2). The patients were divided into the intervention group (empagliflozin) and the control group (27 cases each). The intervention group was treated with 10 mg/day empagliflozin tablets orally, while the control group had adjustments to their basic treatment stage. The patients were treated for 6 weeks.

Results

The baseline clinical data of the two groups were comparable (P˃0.05). The intervention group exhibited better improvements in blood lipid profiles and more significant reductions in blood uric acid levels compared to the control group (P < 0.05). The two groups had No significant difference in blood pressure changes (P˃0.05). Notably, the intervention group demonstrated a greater reduction in UACR and a more substantial decline in eGFR than the control group (P < 0.05). Regarding functional magnetic resonance imaging parameters, the MD value of the renal medulla region in the intervention group increased after treatment, while the MR2* value of the renal medulla region decreased (P < 0.05).

Conclusions

SGLT2 inhibitor empagliflozin can reduce UACR and eGFR levels in early type 2 diabetic patients with normal proteinuria. Moreover, empagliflozin therapy led to an increase in the MD value and a decrease in the MR2* value of the renal medulla, evidencing the early tubular protective effects of this therapy.
Literature
1.
go back to reference Levin A et al (2013) Kidney disease: improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3(1):1–150 Levin A et al (2013) Kidney disease: improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3(1):1–150
2.
go back to reference McQueen RB et al (2017) Economic burden of comorbid chronic kidney disease and diabetes. J Med Econ 20(6):585–591CrossRefPubMed McQueen RB et al (2017) Economic burden of comorbid chronic kidney disease and diabetes. J Med Econ 20(6):585–591CrossRefPubMed
3.
go back to reference Sun H et al (2022) IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 183:109119CrossRefPubMed Sun H et al (2022) IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 183:109119CrossRefPubMed
4.
go back to reference Hoogeveen EK (2022) The epidemiology of diabetic kidney disease. Kidney Dial 2(3):433–442CrossRef Hoogeveen EK (2022) The epidemiology of diabetic kidney disease. Kidney Dial 2(3):433–442CrossRef
5.
go back to reference Duan J et al (2019) Prevalence and risk factors of chronic kidney disease and diabetic kidney disease in Chinese rural residents: a cross-sectional survey. Sci Rep 9(1):10408CrossRefPubMedPubMedCentral Duan J et al (2019) Prevalence and risk factors of chronic kidney disease and diabetic kidney disease in Chinese rural residents: a cross-sectional survey. Sci Rep 9(1):10408CrossRefPubMedPubMedCentral
6.
go back to reference Yang C et al (2020) CKD in China: evolving spectrum and public health implications. Am J Kidney Dis 76(2):258–264CrossRefPubMed Yang C et al (2020) CKD in China: evolving spectrum and public health implications. Am J Kidney Dis 76(2):258–264CrossRefPubMed
7.
go back to reference Gao B et al (2014) Chinese cohort study of chronic kidney disease: design and methods. Chin Med J 127(11):2180–2185CrossRefPubMed Gao B et al (2014) Chinese cohort study of chronic kidney disease: design and methods. Chin Med J 127(11):2180–2185CrossRefPubMed
8.
go back to reference Yu X, Yang X (2015) Peritoneal dialysis in China: meeting the challenge of chronic kidney failure. Am J Kidney Dis 65(1):147–151CrossRefPubMed Yu X, Yang X (2015) Peritoneal dialysis in China: meeting the challenge of chronic kidney failure. Am J Kidney Dis 65(1):147–151CrossRefPubMed
9.
go back to reference Bennett WL et al (2011) Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med 154(9):602–613CrossRefPubMedPubMedCentral Bennett WL et al (2011) Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med 154(9):602–613CrossRefPubMedPubMedCentral
10.
go back to reference Gnudi L, Coward RJ, Long DA (2016) Diabetic nephropathy: perspective on novel molecular mechanisms. Trends Endocrinol Metab 27(11):820–830CrossRefPubMed Gnudi L, Coward RJ, Long DA (2016) Diabetic nephropathy: perspective on novel molecular mechanisms. Trends Endocrinol Metab 27(11):820–830CrossRefPubMed
11.
12.
go back to reference Yang W et al (2017) Efficacy and safety of dapagliflozin in Asian patients: a pooled analysis. J Diabet 9(8):787–799CrossRef Yang W et al (2017) Efficacy and safety of dapagliflozin in Asian patients: a pooled analysis. J Diabet 9(8):787–799CrossRef
13.
go back to reference Wanner C et al (2016) Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 375(4):323–334CrossRefPubMed Wanner C et al (2016) Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 375(4):323–334CrossRefPubMed
14.
go back to reference Wiviott SD et al (2019) Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 380(4):347–357CrossRefPubMed Wiviott SD et al (2019) Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 380(4):347–357CrossRefPubMed
15.
go back to reference Neal B, Perkovic V, Matthews DR (2017) Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 377(21):2099PubMed Neal B, Perkovic V, Matthews DR (2017) Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 377(21):2099PubMed
16.
go back to reference Perkovic V et al (2019) Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 380(24):2295–2306CrossRefPubMed Perkovic V et al (2019) Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 380(24):2295–2306CrossRefPubMed
17.
go back to reference Hegde NC et al (2023) Dose-dependent renoprotection efficacy of sglt2 inhibitors in type 2 diabetes: systematic review and network meta-analysis. Acta Diabetol 60(10):1311–1331CrossRefPubMed Hegde NC et al (2023) Dose-dependent renoprotection efficacy of sglt2 inhibitors in type 2 diabetes: systematic review and network meta-analysis. Acta Diabetol 60(10):1311–1331CrossRefPubMed
18.
go back to reference Gilbert RE (2017) Proximal tubulopathy: prime mover and key therapeutic target in diabetic kidney disease. Diabetes 66(4):791–800CrossRefPubMed Gilbert RE (2017) Proximal tubulopathy: prime mover and key therapeutic target in diabetic kidney disease. Diabetes 66(4):791–800CrossRefPubMed
19.
go back to reference Feng YZ et al (2018) Intravoxel incoherent motion (IVIM) at 3.0 T: evaluation of early renal function changes in type 2 diabetic patients. Abdom Radiol (NY) 43(10):2764–2773CrossRefPubMed Feng YZ et al (2018) Intravoxel incoherent motion (IVIM) at 3.0 T: evaluation of early renal function changes in type 2 diabetic patients. Abdom Radiol (NY) 43(10):2764–2773CrossRefPubMed
21.
go back to reference [Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China (2022 edition)]. Zhonghua Nei Ke Za Zhi, 61(1): 12–50. [Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China (2022 edition)]. Zhonghua Nei Ke Za Zhi, 61(1): 12–50.
23.
go back to reference Zhang F et al (2022) Expert consensus on personalized initiation of glucose-lowering therapy in adults with newly diagnosed type 2 diabetes without clinical cardiovascular disease or chronic kidney disease. J Evid Based Med 15(2):168–179CrossRefPubMed Zhang F et al (2022) Expert consensus on personalized initiation of glucose-lowering therapy in adults with newly diagnosed type 2 diabetes without clinical cardiovascular disease or chronic kidney disease. J Evid Based Med 15(2):168–179CrossRefPubMed
24.
go back to reference Ma YC et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17(10):2937–2944CrossRefPubMed Ma YC et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17(10):2937–2944CrossRefPubMed
25.
26.
go back to reference Zhang Z et al (2023) The value of functional magnetic resonance imaging in the evaluation of diabetic kidney disease: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 14:1226830CrossRefPubMed Zhang Z et al (2023) The value of functional magnetic resonance imaging in the evaluation of diabetic kidney disease: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 14:1226830CrossRefPubMed
27.
go back to reference Heerspink HJ et al (2017) Canagliflozin slows progression of renal function decline independently of glycemic effects. J Am Soc Nephrol 28(1):368–375CrossRefPubMed Heerspink HJ et al (2017) Canagliflozin slows progression of renal function decline independently of glycemic effects. J Am Soc Nephrol 28(1):368–375CrossRefPubMed
28.
go back to reference Fine LG, Norman JT (2008) Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics. Kidney Int 74(7):867–872CrossRefPubMed Fine LG, Norman JT (2008) Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics. Kidney Int 74(7):867–872CrossRefPubMed
29.
go back to reference Ndibalema AR et al (2020) Empagliflozin protects against proximal renal tubular cell injury induced by high glucose via regulation of hypoxia-inducible factor 1-alpha. Diabet Metab Syndr Obes 13:1953–1967CrossRef Ndibalema AR et al (2020) Empagliflozin protects against proximal renal tubular cell injury induced by high glucose via regulation of hypoxia-inducible factor 1-alpha. Diabet Metab Syndr Obes 13:1953–1967CrossRef
30.
go back to reference Laursen JC et al. (2021) Acute effects of dapagliflozin on renal oxygenation and perfusion in type 1 diabetes with albuminuria: a randomised, double-blind, placebo-controlled crossover trial. eClinicalMedicine 37 Laursen JC et al. (2021) Acute effects of dapagliflozin on renal oxygenation and perfusion in type 1 diabetes with albuminuria: a randomised, double-blind, placebo-controlled crossover trial. eClinicalMedicine 37
Metadata
Title
Assessing early tubular protective effects of SGLT2 inhibitor empagliflozin against type 2 diabetes mellitus using functional magnetic resonance imaging
Authors
Chuangbiao Zhang
Beibei Zhu
Youzhen Feng
Zhongyuan Cheng
Xiangran Cai
Lie Feng
Jiaying Li
Xiaohua Lu
Publication date
20-12-2023
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 4/2024
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-023-02220-x

Other articles of this Issue 4/2024

Acta Diabetologica 4/2024 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine