Endocrine Abstracts

Background: Increased liver and cardiac fat are common in patients with type 2 diabetes mellitus (T2DM) and associated with increased risc for liver fibrosis and cardiovascular events. The effect of a DPP-4 inhibitor vildagliptin on the fat content of the liver and heart has not been evaluated.

Methods: A total of 40 patients, 20 males and 20 females, treated at our diabetes metabolic unit of the Medical University of Vienna with gliptins underwent magnetic resonance spectroscopy before and 6 months after start of therapy with vildagliptin twice a day 50 mg as standard add on to metformin. MRT was performed with 3 Tesla Siemens MRT.

Results: A total of 40 patients have been included, 10 patients have finished the study (5 males, 5 females). The mean age was 55.9±7.2, weight 88.3±17, BMI 31.6±5.1 kg/m² and duration of diabetes 6±4 years. After 6 months mean weight loss was 5.1±2.3 kg and −7±3 cm in waist circumference. Systolic and diastolic RR improved significantly: 151.3±2.6/94.2±10 to 122±14.4/80.1±8.9 mmHg (P=0.04, P=0.05) respectively. HbA1c sunk significantly (8.3±1.5 to 6.5±0.4%, P=0.004). Before therapy patients had increased liver fat 15.3±9.1%, women significantly higher than men (30.2±2.5 vs 15.3±3.5, P<0.05) which significantly decreased in the 10 finished patients to 8.8±4.1, P=0.0004, followed by a decrease of cardiac fat of 1.4±0.4%. The cardiac ejection fraction greatly improved (51.4±2.3 to 67.1±0.5%, P<0.0001 as well as the myocardial mass decreased for 10.1±2.4 g.

Conclusion: Vildagliptin is very well tolerated an leads already after 6 months of therapy to significant decrease of liver and cardiac fat, improves the heart function, blood pressure and leads to weight loss where most of the other oral antidiabetics fail. These preliminary data could indicate vildagliptin as first line therapy of fatty liver with a special focus on cardiovascular function improvement.