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Improved Erythrocyte Deformability Induced by Sodium-Glucose Cotransporter 2 Inhibitors in Type 2 Diabetic Patients

Minkook Son1, Ye Sung Lee2, A Ram Hong3

  • 1Department of Biomedical Science and Engineering, School of Mechanical Engineering, Gwangju Institute of Science and Technology, 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005, South Korea.

Cardiovascular Drugs and Therapy
|September 5, 2020
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors improve erythrocyte deformability, a key factor in cardiovascular protection. This finding offers insight into the paradoxical cardiovascular benefits of SGLT-2 inhibitors despite potential increases in blood viscosity.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are antidiabetic drugs known to improve cardiovascular outcomes.
  • Administration of SGLT-2 inhibitors leads to increased hemoglobin and hematocrit, potentially increasing blood viscosity and cardiovascular risk.
  • The mechanisms behind the cardiovascular protective effects of SGLT-2 inhibitors, despite hemorheological changes, remain unclear.

Purpose of the Study:

  • To investigate the effects of SGLT-2 inhibitors on hemorheological parameters.
  • To compare hemorheology in patients treated with SGLT-2 inhibitors versus dipeptidyl peptidase 4 (DPP-4) inhibitors.

Main Methods:

  • Evaluated hemorheological parameters in 63 patients (25 on SGLT-2 inhibitors, 38 on DPP-4 inhibitors, all with metformin).
  • Measured blood viscosity, erythrocyte aggregation, and erythrocyte deformability using specialized viscometry and tomography techniques.
  • Utilized propensity score matching for robust comparison between treatment groups.

Main Results:

  • Erythrocyte deformability was significantly improved in the SGLT-2 inhibitor group compared to the DPP-4 inhibitor group (53.88 ± 4.88 nm vs. 43.71 ± 5.13 nm, p < 0.001).
  • After propensity score matching, erythrocyte deformability remained significantly higher in the SGLT-2 inhibitor group (53.14 ± 4.72 nm vs. 45.01 ± 5.28 nm, p = 0.001).
  • While initial measurements showed increased blood viscosity and erythrocyte aggregation in the SGLT-2 inhibitor group, these differences were not significant after propensity score matching.

Conclusions:

  • SGLT-2 inhibitor treatment significantly improves erythrocyte deformability.
  • Enhanced erythrocyte deformability is a likely contributor to the observed cardiovascular protective effects of SGLT-2 inhibitors.
  • This study elucidates a potential mechanism for the cardiovascular benefits of SGLT-2 inhibitors by improving hemorheology.
Abstract

Keywords:
Blood viscosityDPP-4 inhibitorDeformabilityHemorheologySGLT-2 inhibitorType 2 diabetes

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