Clinical Report: Empagliflozin Tested in Real-World Data

Overview

Empagliflozin is associated with lower all-cause mortality compared to DPP-4 inhibitors in patients with type 2 diabetes, based on a large observational study. The findings support the mortality benefits observed in the EMPA-REG trial, extending its relevance to a broader patient population.

Background

The use of sodium–glucose cotransporter 2 (SGLT2) inhibitors like empagliflozin has gained attention due to their potential cardiovascular and renal benefits in patients with type 2 diabetes. Understanding the real-world effectiveness of empagliflozin is crucial, especially as clinical guidelines increasingly recommend SGLT2 inhibitors for high-risk patients. This study provides insights into the mortality outcomes associated with empagliflozin in a diverse patient population.

Data Highlights

Key Findings

• Empagliflozin was associated with a lower risk of all-cause mortality compared to DPP-4 inhibitors (adjusted hazard ratio of 0.76).
• Only 20.8% of the study cohort met the eligibility criteria of the EMPA-REG trial.
• Among empagliflozin initiators, 83% would not have qualified for the EMPA-REG trial.
• The study included 62,503 adults with type 2 diabetes, with follow-up of up to 9.6 years.
• Estimated 3-year absolute mortality risk reduction for empagliflozin was approximately 2 percentage points, with a number needed to treat of 47.

Clinical Implications

The findings reinforce the importance of considering empagliflozin as a treatment option for patients with type 2 diabetes, particularly those at risk for cardiovascular events. Clinicians should be aware that the mortality benefits of empagliflozin extend beyond the trial population to real-world settings.

Conclusion

This observational study confirms the mortality benefits of empagliflozin in a real-world population, aligning with previous randomized trial findings. Further research is warranted to explore the long-term effects of empagliflozin in diverse patient groups.

References

1. Ryan DK, et al., BMJ Open Diabetes Research & Care, 2023 -- Enhancing evidence-based care using trial emulation in electronic health records: real-world effects of empagliflozin in people with type 2 diabetes
2. Drug Safety, 2022 -- Safety Assessment of Hospitalization for Acute Kidney Injury in Type 2 Diabetes Patients Using Dapagliflozin: A Real-World Post-Authorization Study
3. Drug Safety, 2022 -- Safety Assessments of Acute Liver Injury and Severe Urinary Tract Infection Complications in Type 2 Diabetes Patients Using Dapagliflozin in Real-World Studies
4. The Lancet, 2026 -- Novel SGLT2 Inhibitor Reduces Heart Failure Hospitalization in Diabetic Patients
5. New England Journal of Medicine, 2026 -- Dapagliflozin Reduces Cardiovascular Death in Patients with Heart Failure and Preserved Ejection Fraction
6. Standards of Care in Diabetes | ADA Clinical Guidelines
7. Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients - American College of Cardiology
8. Standards of Care in Diabetes | ADA Clinical Guidelines
9. Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients - American College of Cardiology
10. Enhancing evidence-based care using trial emulation in electronic health records: real-world effects of empagliflozin in people with type 2 diabetes | BMJ Open Diabetes Research & Care