ADA 2020: Empagliflozin reduces insulin need in diabetes patients
Delhi: Treatment with the SGLT2 inhibitor empagliflozin reduces dependency on insulin in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD), a recent study has suggested. The findings of the landmark EMPA-REG OUTCOME trial were presented at the American Diabetes Association 80th Scientific Sessions held from June 12-16, 2020.
According to the study, EMPA markedly delayed the need for insulin initiation in those recently diagnosed and reduced the need for large doses in those already on insulin treatment.
The results are deemed significant as the use of insulin in diabetes patients increases the risk of weight gain and hypoglycemia. Moreover, insulin treatment can be expensive, requires training, and is not generally preferred by patients. Thus, reducing insulin dependency seems beneficial for both practitioners and patients.
Muthiah Vaduganathan, Brigham and Women's Hospital Heart and Vascular Center, Boston, MA, and colleagues deployed 7020 patients in the trial. The patients were treated with empagliflozin (EMPA) 10, 25 mg, or placebo (PBO). They were followed for a median of 3.1 years. Changes in background glucose-lowering therapy were allowed after the first 12 weeks. They assessed treatment effects of pooled EMPA vs. PBO on time to new initiation of insulin among insulin-naïve patients and time to total daily insulin dose increase by >20% among insulin-treated patients.
Key findings of the study include:
- In 3633 (52%) insulin-naïve patients, EMPA reduced need for insulin use vs. PBO by 54% (11.1% vs. 22.3%; HR 0.46), adjusted for key covariates.
- In 3387 (48%) patients using insulin at baseline, EMPA reduced need for a >20% increase in insulin dose by 57% (19.1% vs. 36.8%; HR 0.43).
- Reductions in incident insulin use was most pronounced in patients within 5 yrs of T2D diagnosis (HR 0.31 compared with T2D duration of >5-10 yrs (0.42) or >10 yrs (0.56).
In patients with T2D and CVD EMPA markedly and durably delays the need for insulin initiation, more so in those recently diagnosed, and reduces the need for large dose increases in those already using insulin.
Reference -- ADA 2020 Abstract 30-OR. Empagliflozin Delays Need for Insulin Initiation in Patients with Type 2 Diabetes and Cardiovascular Disease: Findings from EMPA-REG OUTCOME
