The research analyzed multi-institutional electronic health records from January 2016 to August 2023, and assessed more than 4,600 new users of either drug. Of these, 2,649 patients initiated dapagliflozin and 2,046 started empagliflozin. Using advanced statistical methods, including inverse probability of treatment weighting (IPTW), this research balanced patient characteristics to mimic a randomized trial. Ultimately, 1,662 patients were matched in each group for outcome comparison.
The primary measure was a composite outcome of sustained kidney function decline, end-stage renal disease, hospitalization for heart failure, or all-cause mortality, and this showed no significant difference between the two drugs. Similarly, safety outcomes like acute kidney injury, hypoglycemia, urinary tract infection, and fracture occurred at comparable rates across both treatment groups.
Also, when the data were narrowed to patients who lacked stable prior use of ACE inhibitors or angiotensin receptor blockers (ACEI/ARB) empagliflozin users demonstrated a higher risk of all-cause mortality when compared with the individuals on dapagliflozin. This suggests that underlying treatment history may influence outcomes and warrants closer evaluation.
The study revealed marked differences in how the two medications are chosen across medical specialties. Cardiologists tended to favor dapagliflozin, reflecting its strong evidence base in heart failure prevention. Conversely, endocrinologists and nephrologists were more likely to prescribe empagliflozin, likely due to its extensive clinical trial support in glucose control and renal protection.
Each treatment arm had 1,662 patients with balanced baseline characteristics. No statistical difference emerged in rates of kidney decline, progression to end-stage renal disease, or hospitalization for heart failure.
Safety outcomes including the risk of hypoglycemia, urinary tract infections, acute kidney injury, and fractures, remained evenly distributed across both groups. The exception was in patients without stable ACEI/ARB exposure, where empagliflozin was associated with higher mortality risk.
Overall, these findings suggest that for most patients with T2D, both dapagliflozin and empagliflozin offer equivalent protection against cardiorenal events and carry similar safety profiles. Yet, the subtle difference in mortality risk underlines the importance of individualizing treatment based on a patient’s background therapy..
Reference:
Yang, I.-N., Chong, K.-S., Peng, Z.-Y., Ou, H.-T., & Wang, M.-C. (2025). Comparative effectiveness and prescribing patterns of dapagliflozin vs empagliflozin in type 2 diabetes patients: a target trial emulation. Diabetes Research and Clinical Practice, 228(112427), 112427. https://doi.org/10.1016/j.diabres.2025.112427
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