Efeitos da vildagliptina e da metformina sobre as funções endotelial e microvascular, inflamação de baixo-grau e estresse oxidativo em pacientes com obesidade e diabetes mellitus recém-diagnosticadas: estudo de intervenção

Abstract

Even in the early stages of the disease, type 2 diabetes mellitus (T2D) correlates with the worsening of endothelial function and reduction of incretinic capacity, as well as with an increase in postprandial lipemia (PPL). It is expected that patients with T2D and obesityalready have altered endothelial and microvascular reactivities. Consequently, the use of drugs that improve glycemic control and possibly other aspects of the pathophysiology of T2D and vascular damage may bring additional benefits to these patients.In this study, 38 women with newly diagnosed T2D and treatment-naïve, aged between 19 and 50 years and BMI ≥30 kg/m2; were randomized into two groups receiving metformin (1700 mg/day) or vildagliptin (100 mg/day), respectively. At baseline and at the end of 30 days of treatment, endothelial function, lipid profile, inflammatory markers, intestinal peptides and anthropometric data were assessed at fasting period, as well as after ingestion of a lipid-rich meal. At baseline, both groups were statistically similar regarding clinical, metabolic and vascularaspects. At the end of the study, the group treated with vildagliptin for 30 days presented an improvement in endothelium-dependent (P=0.03) and independent vasodilatation (P=0,02) measured by venous occlusion plethysmography (POV), as well as a better vasomotricity, assessed by laser-Doppler flowmetry (LDF) (P<0.05) during the postprandial period (PP) (P<0.05). The metformin group showed better microvascular reactivity in fasting period after 30 days of treatment (P<0.05) and also during PP (P<0.05).We concluded that both drugs used in treatment-naïve patients during short-term periodwere capable of improving vascular function through distinct and complementary mechanisms of action on vascular function. While vildagliptin actedpreferentially on vessels related to peripheral vascular resistance, metformin improved nutritional microflow at capillary level. Thus, both drugs are able to act in the improvement of endothelial function in patients with early-stage T2D, preventing the vascular insult that the disease is able to develop in the long term period. Effects that go beyond simple glycemic control.