Effects of Linagliptin on Left Ventricular Myocardial DYsfunction in Patients With Type 2 DiAbetes Mellitus and Concentric Left Ventricular Geometry

Multicentre, randomized, double blind, parallel group comparison of an DPP-4 inhibitor, linagliptin 5 mg od, versus placebo (1:1) in patients with T2DM and a documented baseline concentric LV geometry and LV systolic dysfunction.

The management of glycemia will be left to the Investigator's judgment informed by clinical guidelines. The Investigator will therefore be allowed to undertake appropriate action, i.e.:

• Adjust the background antidiabetic treatment.
• Prescribe an additional antidiabetic medication according to its labeling (with the exclusion of other DPP-4 inhibitor or GLP-1 receptor agonist).

The enrollment period will last 12 months. The patients will be followed up for 48 weeks from randomization.

After the randomization the patients will have a control visit after 2 weeks (Visit 3) and at 3 months from randomization (Visit 4, week 12). At Visit 4 blood samples will be collected.

Afterwards the patients will have one control visit at 24 weeks from randomization (Visit 5) and a final visit at 48 weeks from randomization (Visit 6) with echocardiogram and ECG performed and blood samples collected.

Patients still on study treatment at the time of final visit (Visit 6) will have a post treatment safety follow up (clinical visit or phone contact) 30 days after the study treatment discontinuation.

Inclusion criteria

• Men and women aged equal to or more than 40 years at screening.
• Patients with history of T2DM lasting at least six month prior to the screening visit.
• HbA1c ≤ 8.0% (≤ 64 mmol/mol) at screening.
• Evidence of sinus rhythm at screening ECG evaluation
• No clinical signs/symptoms of a cardiac disease and no evidence of coronary artery disease on the basis of clinical, electrocardiographic and echocardiographic evaluation at screening.
• Evidence at baseline echocardiographic examination of concentric left ventricular geometry, defined as relative wall thickness ≥ 0.42. Relative wall thickness was calculated as the end-diastolic ratio 2* posterior wall thickness/LV diameter.
• Evidence at baseline echocardiographic examination of LV systolic dysfunction defined as Midwall shortening (MFS) ≤15%
• Obtained informed consent

Exclusion criteria

• Patients with a confirmed indication for an incretin treatment
• Uncontrolled diabetes: HbA1c >8.0% (> 64 mmol/mol) or Fasting Plasma Glucose > 300 mg/dL measured at screening visit.
• Glitazones within the last three months
• Permanent atrial fibrillation
• Uncontrolled hypertension (defined as systolic blood pressure>160 and/or diastolic blood pressure >90)
• Unstable dosage and changes in type of antihypertensive, lipid lowering and antidiabetic drugs within 4 weeks before the screening visit.
• Severe chronic renal dysfunction (defined as estimated glomerular filtration rate < 30 ml/min/1.73 m2).
• Previous or current documented history of untreated (by using CPAP) obstructive sleep apnea syndrome
• Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis.
• Previous or current documented history of malignant disease
• Pregnancy and breast feeding
• Documented alcohol and drug abuse
• Anticipated poor compliance
• Current participation in a clinical trial with other investigational products