In the recent EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), treatment with empagliflozin, a member of the group of antidiabetic sodium-glucose cotransporter 2 inhibitors, reduced cardiovascular mortality and hospitalization for heart failure in patients with type 2 diabetes mellitus and cardiovascular disease.¹ In heart failure and type 2 diabetes mellitus, cardiac metabolic flexibility is impaired, and alteration in glucose or fatty acid (FA) metabolism and changes in the use of ketone bodies and branched chain amino acids (BCAAs) occur.² Because sodium-glucose cotransporter 2 inhibitors lead to a mild increase in ketones, it has been hypothesized that empagliflozin may exhibit some of its beneficial effects through a shift in myocardial metabolism toward an energy-efficient use of ketone bodies, which may improve myocardial work efficiency and function.^3,4 Still, these hypotheses are not proven yet, and data are lacking on the metabolic signature of sodium-glucose cotransporter 2 inhibitor-treated patients. Therefore, we performed an untargeted metabolomics approach in a group of empagliflozin-treated patients with type 2 diabetes mellitus and cardiovascular disease.

In a prospective study (http://www.clinicaltrials.org; unique identifier: NCT03131232; ethics committee approved, and all patients gave informed consent), we enrolled 25 patients with type 2 diabetes mellitus and cardiovascular disease with a clinical indication for intensification of their glucose-lowering therapy and treated them with empagliflozin 10 mg/day. Serum was taken at baseline and after 1 month.

Untargeted …

在最近的EMPA-REG OUTCOME试验（2型糖尿病患者中的恩格列净治疗心血管事件事件试验）中，使用抗糖尿病钠葡萄糖共转运蛋白2抑制剂依帕格列净治疗可以降低患者的心血管疾病死亡率和因心力衰竭而住院与2型糖尿病和心血管疾病有关。¹在心力衰竭和2型糖尿病中，心脏新陈代谢的灵活性受到损害，葡萄糖或脂肪酸（FA）代谢的改变以及酮体和支链氨基酸（BCAAs）的使用发生变化。^2个由于钠-葡萄糖共转运蛋白2抑制剂会导致酮的轻度增加，因此可以推测，依帕列净可能通过将心肌代谢向能量有效地使用酮体转变而显示出某些有益作用，从而可以改善心肌的工作效率。和功能。^3，4尽管如此，这些假设尚未证实，而且数据缺乏对钠-葡萄糖协同转运蛋白2抑制剂治疗的患者的代谢签名。因此，我们在一组接受依格列净治疗的2型糖尿病和心血管疾病患者中进行了非靶向代谢组学研究。

在一项前瞻性研究中（http://www.clinicaltrials.org；唯一标识符：NCT03131232；伦理委员会批准，所有患者均获得知情同意），我们招募了25例2型糖尿病和心血管疾病的患者，并有强化临床指征他们的降糖疗法，并用恩帕格列净10毫克/天治疗。在基线时和1个月后取血清。

未定目标…