Empagliflozin may reduce insulin requirements in type 2 diabetes
medwireNews: Use of the sodium-glucose cotransporter (SGLT)2 inhibitor empagliflozin in people with type 2 diabetes and cardiovascular disease may reduce rates of insulin initiation or intensification, suggests a post-hoc analysis of the EMPA-REG OUTCOME trial.
“These adjunctive treatment benefits may help further inform decision calculus in integrating SGLT-2 inhibitors among eligible patients,” write Javed Butler (University of Mississippi Medical Center, Jackson, USA) and fellow authors in Diabetes, Obesity and Metabolism.
Among 3633 people who were insulin-naïve at baseline, those given empagliflozin were a significant 60% less likely to initiate insulin treatment than those given placebo, at rates of 7.1% and 16.4%, respectively, during a median follow-up of 3.1 years.
Although reductions in insulin initiation with empagliflozin versus placebo occurred across several groups of baseline glycated hemoglobin (HbA1c), the most pronounced decrease was seen in those with levels of at least 8% (64 mmol/mol) but lower than 9% (75 mmol/mol).
Among 3387 individuals receiving insulin at baseline, Butler et al observed that use of empagliflozin was associated with a significant 58% reduced need for a dose increase greater than 20%, with 9.2% of people given empagliflozin and 4.9% of those given placebo requiring such an increase. This association was similar across all subgroups of baseline HbA1c and type 2 diabetes duration.
In addition, people receiving empagliflozin were a significant 1.87 times more likely to achieve sustained insulin dose reductions of over 20% while maintaining glycemic control than people receiving placebo. This result was consistent when considering insulin dose reductions of over 10% or 30% from baseline.
The researchers also estimated the long-term benefits of empagliflozin on insulin-free survival. Assuming the associations seen in the post-hoc analysis would persist, they estimated that insulin-free survival “was longer with empagliflozin than placebo at all ages,” but benefits were inversely related to baseline age, ranging from 1.4 to 11.3 years.
These findings suggest that “empagliflozin meaningfully and durably delayed the requirement for insulin or insulin intensification,” say the researchers.
They note, however, that they “were encouraged to maintain glycemic equipoise” during EMPA-REG-OUTCOME, and “[f]urther data from studies with alternative designs that do not actively encourage glycemic equipoise are needed to corroborate the treatment effects of SGLT-2 inhibitors on longitudinal insulin requirements.”
“If replicated, the long-term implications of these effects on improvement in patient satisfaction, quality of life, and costs of care require further study.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group