Microvascular outcomes with
empagliflozin in patients with type 2 diabetes
-Kathryn A Martin et al., 2016
There are few trials evaluating
microvascular outcomes in patients taking sodium-glucose co-transporter 2
(SGLT2) inhibitors. Microvascular disease was a prespecified secondary
outcome in a recent trial designed specifically to evaluate cardiovascular morbidity
and mortality in patients with type 2 diabetes and established cardiovascular
disease (CVD). In this trial, 7028 patients with type 2 diabetes and
established CVD were randomly assigned to empagliflozin or placebo once daily;
the majority of patients were also taking metformin, antihypertensives, and
lipid-lowering agents. Incident or worsening nephropathy occurred in 12.7 and
18.8 percent of patients in the empagliflozin and placebo groups, respectively.
The reduction in nephropathy drove the improved composite
microvascular endpoint (the initiation of retinal photocoagulation,
vitreous hemorrhage, diabetes-related blindness, or incident or worsening
nephropathy) for empagliflozin. The mechanism behind the reduction in
incident or worsening nephropathy with empagliflozin is likely multifactorial,
but is thought to be largely related to a direct renovascular effect of
empagliflozin. Whether other SGLT2 inhibitors have similar renal effects is
unknown. There have been reports of acute kidney injury, some requiring
hospitalization and dialysis, in patients taking canagliflozin or
dapagliflozin.
By
Dr. G. Saravanan
Associate Professor & Head
Department of Biochemistry
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