Effect of empagliflozin on brachial artery shear stress and endothelial function in subjects with type 2 diabetes: Results from an exploratory study

Empagliflozin reduces the risk of cardiovascular mortality in subjects with type 2 diabetes. We demonstrated that empagliflozin increases blood viscosity and carotid shear stress and decreases carotid wall thickness. Shear stress is the force acting on the endothelial surface and modulates arterial function. The current study evaluates the influence of empagliflozin on brachial artery shear stress and endothelial function compared to incretin-based therapy. The study is a nonrandomized, open, prospective cohort study including 35 subjects with type 2 diabetes administered empagliflozin or incretin-based therapy. Shear stress was calculated with a validated formula, and endothelial function was evaluated using the flow-mediated dilation technique. Both treatments resulted in comparable reductions in blood glucose and glycated haemoglobin. Brachial artery shear stress significantly increased exclusively in the empagliflozin group (61 +/- 20 vs 68 +/- 25 dynes/cm(2), p = 0.04), whereas no significant difference was detected in the incretin-based therapy group (60 +/- 20 vs 55 +/- 12 dynes/cm(2), p = not significant). Flow-mediated dilation significantly increased in the empagliflozin group (4.8 +/- 4.5% vs 8.5 +/- 5.6%, p = 0.03). Again, no change was detected in the incretin-based therapy group (5.1 +/- 4.5% vs 4.7 +/- 4.7%, p = not significant). The present findings demonstrate the beneficial effect of empagliflozin on shear stress and endothelial function in subjects with type 2 diabetes independent of the hypoglycaemic effect.