Empagliflozin: A Review in Type 2 Diabetes

Empagliflozin (Jardiance (R)), a potent, highly selective, sodium glucose cotransporter-2 (SGLT2) inhibitor, is an effective and generally well tolerated antihyperglycaemic agent approved for the treatment of adults with type 2 diabetes (T2D) in the EU, USA and Japan, among other parts of the world. As with other members of its class, empagliflozin offers the convenience of once-daily oral administration and carries a low inherent risk of hypoglycaemia as a result of its insulin-independent mechanism of action, enabling it to be used as monotherapy and as a component of combination therapy with other antidiabetic agents with complementary modes of action to improve glycaemic control in patients with T2D. Beyond lowering glucose, empagliflozin exerts a favourable effect on a number of nonglycaemic outcomes, including modest reductions in bodyweight and blood pressure. As an adjunct to standard care, it demonstrated cardioprotective and renoprotective properties largely independent of glycaemic control in patients with T2D and established cardiovascular disease (CVD) in a mandated cardiovascular (CV) outcomes trial (EMPA-REG OUTCOME). Empagliflozin is generally well tolerated as monotherapy or as add-on therapy and, unlike canagliflozin (the only other SGLT2 inhibitor that has so far shown CV and renal benefits), it has not been associated with an increased risk of amputation or bone fractures. In conclusion, empagliflozin is a valuable treatment option for the management of T2D. Given its demonstrable cardioprotective benefits, the drug is worthy of preferential consideration in patients at high CV risk who require an (additional) antidiabetic medication in order to attain their glycaemic goal.