Discussion
dysglycaemia, T2DM, cardiovascular disease, acute coronary syndrome
CARDIOVASCULAR DISEASE, CHRONIC HYPERGLYCAEMIA, INSULIN RESISTANCE, ACUTE CORONARY SYNDROME, INSULIN SENSITIVITY
The main finding in this investigation of patients with a recent acute coronary syndrome and newly diagnosed dysglycaemia was that (i) seven months of treatment with the SGLT2i empagliflozin improved insulin sensitivity indexes; (ii) changes in those insulin sensitivity indexes were correlated with changes in cardiac volumes as measured by CMR after seven months of empagliflozin therapy; (iii) the impact of empagliflozin was not long-lasting as revealed by the findings from three months after cessation of the drug.Chronic hyperglycaemia impairs both insulin sensitivity and pancreatic insulin secretion, initiating a vicious cycle that gradually increases insulin resistance and deteriorates β-cell function [Our findings partly contradict the results of previous studies. A placebo-controlled clinical study conducted by Merovci et al., reported that two-weeks treatment with dapagliflozin in patients with uncontrolled T2DM not only improved insulin sensitivity (based on euglycaemic clamp), but also led to an improved β-cell function, calculated as the ratio between the change in C-peptide and the change in glucose values during a 2 h OGTT [The fact that plasma mannose, an emerging, sensitive marker of insulin resistance and cardiovascular disease [The specific mechanisms of the beneficial effects of SGLT2i on cardiovascular disease remain to be defined [