Discussion
inflammation, heart failure, hypoxia, type 2 diabetes
HYPOXIA, INFLAMMATION, INSULIN RESISTANCE, HEART FAILURE, TYPE 2 DIABETES
To our knowledge this is the first study that compares the effects of dapagliflozin and glimepiride on glycemic control, insulin resistance and different biomarkers as IRAPe, IL-34, and NT-pro BNP.Our results show that both glimepiride and dapagliflozin have significantly improved the glycemic control in the study patients as they have significantly improved the levels of fasting and 2-h post prandial blood glucose level, and glycated hemoglobin. These findings are in accordance with the findings of Goldberg et al. that showed that glimepiride significantly reduce the levels of FBG, 2-H PPBG, and HbA1C (p < 0.001)HOMA-IR is widely used to assess insulin resistance using fasting glucose and fasting insulinIRAP plays an essential role in the translocation of GLUT-4 to plasma membrane, which plays an important role in the development of insulin resistance. When this translocation happens, the extracellular domain of IRAP (IRAPe) is released into the bloodOur study observed that glimepiride decreased insulin resistance without having a significant effect on IRAPe level this may be attributed to HOMA-IR, that used as indicator for insulin resistance, which calculated based on fasting insulin and fasting glucose concentration. Glimepiride was found to stimulate glucose transport by affecting GLUT-1 and GLUT-4Another possible explanation is that IRAPe may require more time to be improved in response to glimepiride or may require higher doses of glimepiride. And since our study is relatively short and the sample size is relatively small we cannot confirm the exact explanation.We also found that dapagliflozin has significantly improved the level of IRAPe, but since the significance level is very close to the significance threshold and since our sample size is relatively small and the duration of the study is relatively short, this result needs to be confirmed with longer duration and larger sample size study. The difference between dapagliflozin and glimepiride effects on IRAPe is non-significant. We found that Glimepiride has significantly improved the level of IL-34, unlike dapagliflozin that do not have significant effect on its level. There is a significant difference between the effect of both drugs on IL-34. These findings may be explained as IL-34 is alternative ligand for colony stimulating factor-1 (CSF-1). IL-34 has been found to be involved in the inflammation and development of insulin resistanceNT-proBNP are biomarkers that are released from the heart in response to inflammation, hypoxia, or myocardial stretching. They have been proved to be a useful marker for the prediction of the development of heart failure in patients with type 2 diabetes