Diabetes mellitus is a metabolic disease with a growing prevalence worldwide. Currently
available therapies for type 2 diabetes have various limitations and are associated with
increased risk of hypoglycemia, weight gain, gastrointestinal side effects or edema and heart
failure.
A new and promising class of drugs are the gliptins. Several efficacy studies demonstrated a
significant improvement of HbA1c with gliptins. In addition, gliptins improved fasting as
well as prandial glucose levels and did not induce weight gain. Due to these positive
metabolic effects in combination with a very small spectrum of side effects gliptins might
very well be part of the standard therapy for type 2 diabetes in the future.
Apart form surrogate parameters like reduction of fasting and postprandial blood glucose
levels or improvement of HbA1c, the effect of gliptins on micro- and macrovascular function
and cardiovascular outcome has not been the primary focus of current studies. Diabetes
mellitus is strongly associated with microangiopathy and macroangiopathy and is a strong
independent risk factor for cardiovascular disease and cardiovascular mortality. Endothelial
dysfunction which plays a crucial role in the atherosclerotic process is commonly observed in
patients with diabetes mellitus and already prediabetes and has - amongst other factors -
been linked to fasting and postprandial hyperglycemia. Taken into account that gliptins
reduce hyperglycemia and hyperglycemic peaks by preventing inactivation of GLP-1, which
exerted beneficial effects on the endothelium in previous studies it is of major interest
whether therapy with gliptins improves endothelial function.