Is it possible to extend the life of diabetics thanks to modern treatment?
People aged 60 with type 2 diabetes are estimated to live on average 6-7 years less compared to their peers without a diabetes diagnosis. However, clinical study results suggest that modern therapy can prevent these lost years.
100 days of life lost per year of poorly controlled diabetes
According to a British analysis published in 2020, both type 1 and type 2 diabetes shorten life expectancy across all age groups. Models estimate that one year with a glycated hemoglobin value above 58 mmol/mol shortens life by approximately 100 days.2
Empagliflozin – reducing the risk of death in type 2 diabetics
One of the modern antidiabetics is the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin. Its impact on the expected life expectancy of type 2 diabetics in various age categories was evaluated using data analysis from the randomized EMPA-REG OUTCOME study, which included more than 7,000 patients with type 2 diabetes and cardiovascular disease. Adding empagliflozin to standard treatment resulted in the following compared to placebo:1
- a 32% reduction in the risk of death from all causes
- a 38% reduction in the risk of death from cardiovascular causes
The analysis results showed an extension of the estimated average survival time in diabetics using empagliflozin in all evaluated age categories compared to placebo. Although the absolute increase in average survival time decreased with age, the relative extension of the average survival time for this therapy was 12–15% in all age categories:
- for 45-year-olds by 4.5 years (average survival time 32.1 years with empagliflozin vs. 27.6 years with placebo)
- for 50-year-olds by 3.1 years (28.5 vs. 25.4 years)
- for 60-year-olds by 2.5 years (21.8 vs. 19.2 years)
- for 70-year-olds by 2 years (14.8 vs. 12.8 years)
- for 80-year-olds by 1 year (7.7 vs. 6.7 years)
The benefits of empagliflozin also include:4, 5
- an average weight loss of 1.5–4 kg
- a long-term effect on reducing HbA1c levels
- a reduction in both systolic and diastolic blood pressure
- a low risk of hypoglycemia
- cardiovascular benefits
Who can prescribe empagliflozin to diabetics and what are the reimbursement conditions
Empagliflozin is among the antidiabetics that are currently prescribed by doctors specializing in internal medicine, endocrinology, and diabetology. In the Czech Republic, empagliflozin is reimbursed for type 2 diabetics at a maximum dose of 10 mg per day (packages of 30 or 90 tablets) in the following cases:
- In combination with metformin for patients where the use of the maximum tolerated doses of metformin for at least 3 months combined with lifestyle measures did not lead to satisfactory diabetes control defined by HbA1c levels < 60 mmol/mol. The drug is further not reimbursed if there is no detectable improvement in diabetes control and concurrent weight loss after 6 months of therapy.
- In combination with metformin and insulin or insulin alone for patients where metformin and insulin therapy or insulin alone for at least 3 months combined with lifestyle measures did not lead to satisfactory diabetes control defined by HbA1c levels < 60 mmol/mol. The product is not further reimbursed if there is no detectable improvement in diabetes control and concurrent weight loss after 6 months of treatment.3
In addition to the indication for type 2 diabetes, empagliflozin is also indicated for heart failure regardless of the left ventricular ejection fraction (LVEF). For patients with heart failure with LVEF > 40%, the product is currently not reimbursed in the Czech Republic. However, since May 1, 2022, empagliflozin 10 mg (package of 28 tablets) has been reimbursed for heart failure with reduced LVEF ≤ 40% and simultaneously eGFR > 20 ml/min/1.73 m2, for those who continue to have symptomatic class NYHA II–III despite optimal treatment, prescribed by doctors specialized in cardiology, pediatric cardiology, angiology, and internal medicine.
Conclusion
For patients with type 2 diabetes and cardiovascular disease, adding empagliflozin to standard treatment was observed to extend the estimated average life expectancy compared to placebo within the study. Achieving diabetes control according to the individual treatment goal using modern antidiabetics with proven cardioprotection and managing all cardiovascular risk factors with good patient adherence to treatment is a key premise that allows approximating the life expectancy of diabetics to the general population.
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Sources:
1. Claggett B., Lachin J. M., Hantel S. et al. Long-term benefit of empagliflozin on life expectancy in patients with type 2 diabetes mellitus and established cardiovascular disease. Circulation 2018; 138 (15): 1599–1601, doi: 10.1161/CIRCULATIONAHA.118.033810.
2. Heald A. H., Stedman M., Davies M. et al. Estimating life years lost to diabetes: outcomes from analysis of National Diabetes Audit and Office of National Statistics data. Cardiovasc Endocrinol Metab 2020; 9 (4): 183–185, doi: 10.1097/XCE.0000000000000210.
3. Jardiance, informace o základní úhradě. Databáze léků. SÚKL, 2022. Available at: www.sukl.cz/modules/medication/detail.php?code=0210023&tab=prices
4. Prázný M., Slíva J. Empagliflozin – nový zástupce inhibitorů transportéru SGLT2 pro léčbu pacientů s diabetem 2. typu. Vnitřní lékařství 2015; 61 (2): 175–178.
5. Zinman B., Wanner C., Lachin J. M. et al.; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373 (22): 2117–2128, doi: 10.1056/NEJMoa1504720.
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