ADA 2020 — Empagliflozin tied to reduced insulin need in type 2 diabetes


  • Antara Ghosh
  • Conference Reports
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Takeaway

  • Patients with type 2 diabetes (T2D) at high risk for cardiovascular disease receiving empagliflozin showed a reduced need to either start insulin treatment or intensify existing insulin treatment.

Why this matters

  • Reducing insulin need is attractive to both patients and practitioners.

Study design

  • The EMPA-REG OUTCOME trial randomly allocated 7020 patients with T2D and cardiovascular disease to receive either 10 or 25 mg of empagliflozin or placebo once daily.
  • This post hoc analysis of EMPA-REG OUTCOME evaluated treatment effects of pooled empagliflozin vs placebo on:
    • time to insulin initiation among insulin-naïve patients; and
    • time to total daily insulin dose increase by >20% among insulin-treated patients.
  • Funding: EMPA-REG OUTCOME funded in part by Boehringer Ingelheim and Eli Lilly.

Key results

  • After 4 years, the rate of initiating insulin treatment in empagliflozin vs placebo was 9% vs 20%, respectively.
  • This corresponded to a statistically significant relative risk reduction of 60% in the need for insulin use with empagliflozin vs placebo.
  • Among patients using insulin at baseline, 18% vs 35% of patients receiving empagliflozin vs placebo, respectively, required a significant increase in insulin dose.
  • This corresponded to a significant 58% relative reduction in the need for boosting insulin dosage with empagliflozin vs placebo.

Limitations

  • Post hoc analysis.

Expert commentary

Dr Muthiah Vaduganathan, MD, a cardiologist at Brigham and Women’s Hospital in Boston, said: “Patients are very attuned to potentially needing insulin and often ask about it. A reduced need for insulin will be an important part of the risk and benefit conversation.”