Impact of EMPA-REG OUTCOME^® on the management of type 2 diabetes mellitus: a review for primary care physicians

ABSTRACT

Cardiovascular (CV) disease is the leading cause of death in patients with type 2 diabetes mellitus (T2DM). Most published trials of glucose-lowering agents have shown no significant CV benefit or increased risk of death or heart failure, with the exception of metformin. Three novel classes of glucose-lowering agents, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and sodium glucose cotransporter 2 (SGLT2) inhibitors, have been approved by the U.S. Food and Drug Administration for the treatment of T2DM in the United States and have also been available in other parts of the world in the past decade. Of the SGLT2 inhibitors, empagliflozin has demonstrated a CV benefit in the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME®) while trials with other SGLT2 inhibitors are still ongoing. Empagliflozin has also provided possible renal protective benefit in those with mild-to-moderate renal impairment. The mechanisms behind the benefits seen with empagliflozin are likely multifactorial. Empagliflozin is the reasonable choice for add-on therapy in patients with long-standing T2DM who are at high CV risk as demonstrated in the EMPA-REG OUTCOME® study.

KEYWORDS:

• Cardiovascular benefit
• cardiovascular safety
• EMPA-REG OUTCOME®
• empagliflozin
• primary care physicians
• sodium glucose cotransporter 2 inhibitors
• type 2 diabetes

Declaration of interest

Editorial support was provided by Linda Merkel, PhD, of Envision Scientific Solutions, which was contracted and funded by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI). BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

Editorial support as detailed below was funded by Boehringer Ingelheim Pharmaceuticals, Inc.