Effect of SGLT2 Inhibition on OCT-A Parameters in Diabetic CKD
Status:
Recruiting
Trial end date:
2020-08-01
Target enrollment:
Participant gender:
Summary
Diabetes mellitus is a major and growing problem worldwide with many known micro and
macrovascular complications. According to International Diabetes Federation, there were 285
million adults diagnosed with diabetes in 2010 and expected to increase to 439 million adult
in 2030. It is a leading cause of chronic kidney disease (CKD) followed by hypertension,
glomerulonephritis, and cystic kidney disease. Renal impairment patients metabolize and
excrete drugs differently from patients with normal renal function and hence only limited
number of oral hypoglycemic agent (OHA) available for them. One of the choices is sodium
glucose co-transporter-2 inhibitor (SGLT2i) which is now widely used. Apart from its
nephroprotective advantage, it also has additional benefit on cardiovascular and renal
function based on EMPA-REG OUTCOME trial. One of the examples of SGLT2i is Empagliflozin
(JARDIANCE) tablet, which has FDA U.S. Approval in 2014. It acts by reduces renal
reabsorption of filtered glucose and lowers the renal threshold for glucose, thus increases
urinary glucose excretion. It can cause osmotic diuresis, which may lead to intravascular
volume contraction. Apart from its additional cardiovascular and nephroprotective effect,
SGLT2 inhibitor might have additional protective effect to the eye. Nowadays, optical
coherence tomography angiography (OCT-A) has emerged as one of a non-invasive methods to
study the microvasculature of the retina and choroid. Many studies had discussed
regarding-pre clinical changes present on OCT-A in patients without clinical diabetic
retinopathy. These pre-clinical changes includes capillary dropout, microaneurysm,
neovascularization, venous beading and enlargement of fovea avascular zone. However, there
are minimal data and publications on different type of diabetic CKD with OCT-A parameters in
diabetic patients. The purpose of this study is to determine the effect of short term SGLT2
inhibition on OCT-A parameters (fovea avascular zone (FAZ) size, vessel density and perfusion
density) in diabetic CKD.