Empagliflozin - Insulin Independent Control of Glycaemic Parameters in Diabetes mellitus Type 2 by Inhibition of the Sodium Glucose Linked Transporter SGLT2 (vol 10, pg 247, 2015)

The new oral antidiabetic drug empagliflozin is a selective inhibitor of the active sodium glucose linked transporter 2 (SGLT2) for an insulin independent control of blood sugar in diabetes mellitus type 2; it is approved in the EU since May 2014. Inhibition of SGLT2 is a new mode of action to lower blood glucose levels by inhibiting renal glucose reabsorption resulting in increased urinary glucose excretion. Lowering of fasting and postprandial blood glucose levels occurs independent of insulin action, insulin secretion, extent of insulin resistance, and loss of beta cell function. There is no intrinsic risk for hypoglycemia. In addition, SGLT2 inhibition through empagliflozin reduces body weight and lowers blood pressure. This review describes the mode of action of SGLT2 inhibition and summarizes the clinical data available on the use of empagliflozin as single agent, when combined with other oral antidiabetics (including pooled data), and when combined with insulins. Reduction of HbA1c was the primary outcome of these studies. In all seven studies, as well as in the pooled analysis, mean HbA1c reduction with empagliflozin (10 or 25mg/day) was clinically relevant and statistically significant versus placebo and sulfonylurea glimepiride. Depending on study design and dosage used, empagliflozin showed placebo corrected HbA1c reductions of up to 0.9% after 24 weeks of treatment.