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Adding an SGLT2 to Insulin Improved Control

Adding an SGLT2 inhibitor to multiple daily doses of insulin improved glycemic control, benefited weight loss, lowered insulin doses, and no increase in hypoglycemia was seen…
 
Some patients with inadequately controlled type 2 diabetes still do not achieve glycemic control with multiple daily doses of insulin. Empagliflozin is a potent and selective sodium glucose co-transporter 2 (SGLT2) inhibitor that reduces renal glucose reabsorption. Previous studies have shown that empagliflozin improved glycemic control, reduced body weight both as monotherapy and as add-on therapy to different glucose lowering strategies.
In a new study, researchers evaluated the efficacy and safety of 52 weeks of once daily empagliflozin 10mg (n=186) and 25mg (n=189) vs placebo (n=188) as add-on therapy to MDI insulin +/- metformin in obese patients with inadequately controlled type 2 diabetes. The mean of HbA1c 8.3% (67 mmol/mol), BMI 34.8 kg/m2, and insulin dose 92 IU/day. The primary outcome was change from baseline in HbA1c at week 18. Secondary outcomes were changes from baseline in insulin dose, weight, and HbA1c at week 52.
HbA1c at week 18 was -0.50 +/-0.05% with placebo as compared with -0.94 +/-0.05% with empagliflozin 10mg and -1.02 +/-0.05% with 25mg.
The results over 52 weeks of treatment:
  • HbA1c and FPG were reduced by adding
  • Body weight was significantly reduced in empagliflozin groups compared to an increase in placebo
  • Adverse events: in placebo 58% compared to empagliflozin groups
Researchers concluded that adding empagliflozin 10mg or 25mg once daily improved glycemic control, contributed to weight loss, and did not increase the risk of hypoglycemia compared to multiple daily injections of insulin alone in obese inadequately controlled type 2 diabetes.
Practice Pearls:
  • In obese inadequately controlled type 2 diabetes, adding empagliflozin with insulin improved glycemic control and reduced weight.
  • Empagliflozin can be use as monotherapy or as add-on in type 2 diabetes.
  • Empagliflozin may provide a new treatment option in difficult to treat type 2 diabetes population.
“Diabetes Care.” Improved Glucose Control With Weight Loss, Lower Insulin Doses, and No Increased Hypoglycemia With Empagliflozin Added to Titrated Multiple Daily Injections of Insulin in Obese Inadequately Controlled Type 2 Diabetes. N.p., n.d. Web. 13 Oct. 2014.