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Fernandes VHR, Chaves FRP, Soares AAS, Breder I, Kimura-Medorima ST, Munhoz DB, Cintra RMR, Breder JC, Barreto J, Nadruz W, Carvalho LSF, Quinaglia T, Arieta CEL, Sposito AC. Dapagliflozin increases retinal thickness in type 2 diabetic patients as compared with glibenclamide: A randomized controlled trial. Diabetes Metab 2021; 47:101280. [PMID: 34537385 DOI: 10.1016/j.diabet.2021.101280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/18/2021] [Accepted: 09/04/2021] [Indexed: 11/25/2022]
Abstract
AIM In patients with type 2 diabetes mellitus (T2DM) a progressive thinning in the central retinal thickness (CRT) is mainly related to neuroretinal degeneration and occurs before the decline in visual acuity or capillary density. We investigated the change in CRT by optical coherence tomography (OCT) in T2DM patients after 12 weeks of treatment with dapagliflozin or glibenclamide. METHODS Ninety-seven patients (57 ± 7 years) with T2DM and clinical or subclinical atherosclerosis were randomized 1:1 to dapagliflozin (10 mg/day) or glibenclamide (5 mg/day) on top of metformin XR 1.5 g/day. OCT was obtained in all patients enrolled in the study, both at the time of randomization and at the end of the study. RESULTS Baseline and post-treatment values of fasting glucose and glycated hemoglobin were equivalent in the two arms. There was no difference in change in diabetic retinopathy status after therapy. The center subfield thickness changed by +2(6)μm in the dapagliflozin group and by -1(7) μm in the glibenclamide group (P = 0.001). CONCLUSION A short-term treatment with dapagliflozin may increase CRT as compared with equivalent glycemic control with glibenclamide.
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Affiliation(s)
| | | | | | - Ikaro Breder
- State University of Campinas Medical School, Campinas, SP, Brazil
| | | | - Daniel B Munhoz
- State University of Campinas Medical School, Campinas, SP, Brazil
| | | | | | - Joaquim Barreto
- State University of Campinas Medical School, Campinas, SP, Brazil
| | - Wilson Nadruz
- State University of Campinas Medical School, Campinas, SP, Brazil
| | | | - Thiago Quinaglia
- State University of Campinas Medical School, Campinas, SP, Brazil
| | | | - Andrei C Sposito
- State University of Campinas Medical School, Campinas, SP, Brazil.
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- State University of Campinas Medical School, Campinas, SP, Brazil
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Cintra RMR, Soares AAS, Breder I, Munhoz DB, Barreto J, Kimura-Medorima ST, Cavalcante P, Zanchetta R, Breder JC, Moreira C, Virginio VW, Bonilha I, Lima-Junior JC, Coelho-Filho OR, Wolf VLW, Guerra-Junior G, Oliveira DC, Haeitmann R, Fernandes VHR, Nadruz W, Chaves FRP, Arieta CEL, Quinaglia T, Sposito AC. Assessment of dapagliflozin effect on diabetic endothelial dysfunction of brachial artery (ADDENDA-BHS2 trial): rationale, design, and baseline characteristics of a randomized controlled trial. Diabetol Metab Syndr 2019; 11:62. [PMID: 31384310 PMCID: PMC6668143 DOI: 10.1186/s13098-019-0457-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endothelial dysfunction (ED) is a hallmark in type 2 diabetes mellitus (T2DM) that favor both atherogenesis and ischemia and reperfusion injury (IRI). Sodium-glucose-2 co-transporter inhibitors (SGLT2i) may hypothetically improve microvascular and macrovascular functions via a broad spectrum of mechanisms, being superior to traditional antidiabetic therapy such as sulfonylurea, even in subjects under equivalent glycemic control. Hence, the present clinical trial was designed to compare the effect of these two treatments on markers of arterial wall function and inflammation in T2DM patients as well as on the potential mediating parameters. METHOD AND RESULTS ADDENDA-BHS2 is a prospective, single-center, active-controlled, open, randomized trial. Ninety-eight participants (40-70 years old) with HbA1c 7-9% were randomized (1:1, stratified by gender, BMI and HbA1c levels) to either dapagliflozin 10 mg/day or glibenclamide 5 mg/day on top of metformin. The primary endpoint was the change of flow-mediated dilation (FMD) after a 12-week period of treatment evaluated at rest and after IRI between dapagliflozin and glibenclamide arms. Secondary outcomes were defined as the difference between treatments regarding: plasma nitric oxide (NO) change after FMD, plasma isoprostane, plasma levels of vascular inflammatory markers and systemic inflammatory markers, plasma levels of adipokines, anthropometric measures, glucose control parameters, office and ambulatory BP control. Safety endpoints were defined as systolic and diastolic function assessed by echocardiography and retinopathy change. Serious adverse events were recorded. The study protocol was approved by the Independent Scientific Advisory Committee. CONCLUSION The ADDENDA-BHS2 trial is an investigator-initiated clinical trial comparing the effect of dapagliflozin versus glibenclamide on several aspects of vascular function in high cardiovascular risk T2DM patients. Besides, a large clinical and biochemical phenotype assessment will be obtained for exploring potential mediations and associations.Trial registration Clinical trial registration: NCT02919345 (September, 2016).
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Affiliation(s)
- Riobaldo M. R. Cintra
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Alexandre A. S. Soares
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Ikaro Breder
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Daniel B. Munhoz
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Joaquim Barreto
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Sheila T. Kimura-Medorima
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Pamela Cavalcante
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Renata Zanchetta
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Jessica Cunha Breder
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Camila Moreira
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vitor W. Virginio
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Isabella Bonilha
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Jose Carlos Lima-Junior
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Otavio R. Coelho-Filho
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vaneza L. W. Wolf
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Gil Guerra-Junior
- Growth and Body Composition Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Daniela C. Oliveira
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Rodrigo Haeitmann
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vicente H. R. Fernandes
- Growth and Body Composition Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Wilson Nadruz
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Fernando R. P. Chaves
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Carlos E. L. Arieta
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Thiago Quinaglia
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Andrei C. Sposito
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
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Senne FMBD, Temporini ER, Arieta CEL, Pacheco KD. Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy. Clinics (Sao Paulo) 2010; 65:459-68. [PMID: 20535363 PMCID: PMC2882539 DOI: 10.1590/s1807-59322010000500002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 10/19/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the influence of Nd:YAG (neodymium: yttrium-aluminum- garnet) laser unilateral posterior capsulotomy on visual acuity and patients' perception of difficulties with vision-related activities of daily life. METHODS We conducted an interventional survey that included 48 patients between 40 and 80 years of age with uni- or bilateral pseudophakia, posterior capsule opacification, and visual acuity <or=0.30 (logMAR) in one eye who were seen at a Brazilian university hospital. All patients underwent posterior capsulotomy using an Nd:YAG laser. Before and after the intervention, patients were asked to complete a questionnaire that was developed in an exploratory study. RESULTS Before posterior capsulotomy, the median visual acuity (logMAR) of the included patients was 0.52 (range 0.30-1.60). After posterior capsulotomy, the median visual acuity of the included patients improved to 0.10 (range 0.0-0.52). According to the subjects' perceptions, their ability to perform most of their daily life activities improved after the intervention (p<0.05). CONCLUSIONS After patients underwent posterior capsulotomy with an Nd:YAG laser, a significant improvement in the visual acuity of the treated eye was observed. Additionally, subjects felt that they experienced less difficulty performing most of their vision-dependent activities of daily living.
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Affiliation(s)
- Firmani M B de Senne
- Department of Ophthalmology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP, Brazil.
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Lupinacci APC, da Silva Jordão ML, Massa G, Arieta CEL, Costa VP. Central corneal thickness in children with congenital cataract and children with surgical aphakia: a case-control study. Br J Ophthalmol 2008; 93:337-41. [PMID: 19019924 DOI: 10.1136/bjo.2008.137596] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To measure the central corneal thickness (CCT) of children with congenital cataract and surgical aphakia. METHODS Children with congenital cataract or surgical aphakia were prospectively recruited and divided into four groups: unilateral cataract (group 1, n = 14), bilateral cataract (group 2, n = 17), unilateral aphakia (group 3, n = 32) and bilateral aphakia (group 4, n = 44). An age-, sex-, and race-matched control group of normal individuals was selected. Ultrasonic pachymetry was performed by the same observer. RESULTS The mean CCT of the control group was not significantly different from the normal (p = 0.747) and cataractous eyes of group 1 (p = 0.252). The mean CCTs of both eyes of group 2 were significantly higher than the control group (p<0.01). The mean CCT of the aphakic eyes in group 3 was significantly higher than the contralateral healthy eyes and control eyes (p<0.001). The mean CCTs of both eyes of group 4 were significantly higher than the control group (p<0.001). The mean CCT was significantly higher in aphakic eyes of groups 3 and 4 than in cataractous eyes of groups 1 and 2 (p<0.001). CONCLUSIONS Aphakic eyes due to congenital cataract show thicker corneas than normal phakic eyes. Aphakic eyes after congenital cataract extraction show thicker corneas than eyes with congenital cataracts, suggesting that the increase in CCT occurs postoperatively.
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Affiliation(s)
- A P C Lupinacci
- Department of Ophthalmology, University of Campinas, Campinas, SP, Brazil, R. Mario de Andrade, 201 casa 43, Campo Grande, MS 79032-260, Brazil.
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Abstract
AIM To evaluate the epidemiological characteristics of retinal detachment in a defined urban population in the Southeast of Brazil. METHODS A retrospective study of patients consulted at the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil, with retinal detachment between June 1, 2003 and July 31, 2004. Data were entered into the Statistical Package for the Social Sciences (version 10.0). RESULTS There were a total population of 3 389 294 in the 42 cities of Campinas catchment area. A total of 313 patients fitted the inclusion criteria. The overall demand incidence of retinal detachment was 9.2:100,000. The number of males peaked in the 50-79 age group, whereas that of the females peaked in the 60 to 80+ age group. The ages ranged from 4 months to 84 years (mean 49.3). The female-to-male ratio was 1:2.1. Nontraumatic phakic detachments had the highest demand incidence of 7.1:100,000. The demand incidence of nontraumatic aphakic detachments was very low at 0.09:100,000. Almost one third of all patients seeking treatment presented inoperable cases of retinal detachments. CONCLUSIONS This is the first study of demand incidence of retinal detachment in Latin Americans. The age-specific demand incidence increases with age. Nontraumatic phakic detachments were the most common type of detachment. The incidence of the traumatic types of detachment was higher in males than that in females. Such data are important to plan and implement vitreoretinal services taking into account the population likely to be served.
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Affiliation(s)
- P H Limeira-Soares
- Department of Ophthalmology, School of Medical Sciences, State University of Campinas, São Paulo, Brazil. limeira@ fcm.unicamp.br
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