Empagliflozin – moving from secondary prevention to early intervention
Authors:
Peter Novodvorský 1,2,3
Authors‘ workplace:
metabolické centrum s. r. o., Trenčín
1; Centrum diabetologie IKEM, Praha
2; I. interná klinika JLF UK a UNM, Martin
3
Published in:
Forum Diab 2024; 13(3): 143-146
Category:
Review Article
Overview
Empagliflozin is a sodium-glucose co-transporter 2 inhibitor (SGLT2i) primarily developed as an oral antidiabetic drug. Later on, evidence from large randomized controlled trials showed that empagliflozin has multiorgan benefits far exceeding its glucose lowering effects. At present empagliflozin has antidiabetic, cardiac and renal indications whereby the last two mentioned are independent on the presence of the diagnosis of diabetes. These data thus fit into the newly formulated concept of cardio-renal-metabolic (CRM) syndrome (or CKM – cardiovascular-kidney-metabolic syndrome). Targeted and early therapeutic intervention against CRM syndrome, with medications like empagliflozin, has profound positive effects on the health outcomes of the whole population. This article reviews the relevant clinical studies and real world evidence (RWE) data and their impact on clinical practice.
Keywords:
SGLT2 inhibitors – empagliflozin – early intervention – cardio-reno-metabolic syndrome
Sources
Luippold G, Klein T, Mark M et al. Empagliflozin, a novel potent and selective SGLT-2 inhibitor, improves glycaemic control alone and in combination with insulin in streptozotocin-induced diabetic rats, a model of type 1 diabetes mellitus. Diabetes Obes Metab 2012; 14(7): 601–607. Dostupné z DOI: <http://doi: 10.1111/j.1463–1326.2012.01569.x>.
Zinman B, Wanner C, Lachin JM et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI: <http://doi: 10.1056/NEJMoa1504720>.
Packer M, Anker SD, Butler J et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med 2020; 383(15): 1413–1424. Dostupné z DOI: <http://doi: 10.1056/NEJMoa2022190>.
Anker SD, Butler J, Filippatos G et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med 2021; 385(16): 1451–1461. Dostupné z DOI: <http://doi: 10.1056/NEJMoa2107038>.
Wanner C, Inzucchi SE, Lachin JM et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med 2016; 375(4): 323–334. Dostupné z DOI: <http://doi: 10.1056/NEJMoa1515920>.
Koenen M, Hill MA, Cohen P et al. Obesity, Adipose Tissue and Vascular Dysfunction. Circ Res 2021; 128(7): 951–968. Dostupné z DOI: <http://doi: 10.1161/CIRCRESAHA.121.318093>.
Rangaswami J, Bhalla V, Blair JEA et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation 2019; 139(16): e840-e878. Dostupné z DOI: <http://doi: 10.1161/CIR.0000000000000664>.
Ndumele CE, Rangaswami J, Chow SL et al. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023; 148(20): 1606–1635. Dostupné z DOI: <http://doi: 10.1161/CIR.0000000000001184>.
Melzer Cohen C, Schechter M, Rozenberg A et al. Long-Term, Real-World Kidney Outcomes with SGLT2i versus DPP4i in Type 2 Diabetes without Cardiovascular or Kidney Disease. Clin J Am Soc Nephrol 2023; 18(9): 1153–1162. Dostupné z DOI: <http://doi: 10.2215/CJN.0000000000000218>.
Balasubramanian P, Wanner C, Ferreira JP et al. Empagliflozin and Decreased Risk of Nephrolithiasis: A Potential New Role for SGLT2 Inhibition? J Clin Endocrinol Metab 2022; 107(7): e3003-e3007. Dostupné z DOI: <http://doi: 10.1210/clinem/dgac154>.
Dutka M, Bobinski R, Francuz T et al. SGLT-2 Inhibitors in Cancer Treatment-Mechanisms of Action and Emerging New Perspectives. Cancers (Basel) 2022; 14(23): 5811. Dostupné z DOI: <http://doi: 10.3390/cancers14235811>.
Wu W, Wang Y, Xie J et al. Empagliflozin: a potential anticancer drug. Discov Oncol 2023; 14(1): 127. Dostupné z DOI: <http://doi: 10.1007/s12672–023–00719-x>.
Davies MJ, Aroda VR, Collins BS et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022; 45(11): 2753–2786. Dostupné z DOI: <http://doi: 10.2337/dci22–0034>.
Martinka E, Mokáň M, Rašlová K (eds) et al. Interdisciplinárne odporúčania pre diagnostiku a liečbu diabetes mellitus, jeho komplikácií a najvýznamnejších sprievodných ochorení – 2021. Forum Diab 2021; 10(Suppl 2).
Lacka J, Martinka E, Uličiansky V (eds) et al. Štandardné postupy. Komplexný manažment diabetikov 2. typu – 2024. Dostupné z WWW: <https://www.standardnepostupy.sk/standardy-diabetologia>.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
2024 Issue 3
Most read in this issue
- 2024: hypoglycaemia in focus
- Modern technologies in the prevention of hypoglycaemia
- Hypoglycemia in patients on hemodialysis with diabetes mellitus
- Non-diabetic forms of hypoglycemia in the pediatric population