Empagliflozin shows promise in improving insulin sensitivity in high-risk cardiovascular patients with dysglycaemia

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Empagliflozin has potential as a safe first-line treatment for glucose regulation in patients with recently diagnosed dysglycaemia and a recent coronary event, according toa study.

Empagliflozin has been recognized for its ability to reduce the risk of cardiovascular disease in patients with type 2 diabetes and high cardiovascular risk, though the exact mechanisms underlying this effect have remained elusive. The study sought to investigate whether empagliflozin could be safely administered as a first-line treatment in individuals with cardiovascular disease during the early stages of glycaemic disturbances, such as impaired glucose tolerance (IGT) or type 2 diabetes (T2DM).

The research comprised 42 patients who had experienced a recent acute coronary event, either a myocardial infarction (n = 36) or unstable angina (n = 6), and were newly diagnosed with dysglycaemia. The patients were randomly assigned to receive either a daily dose of empagliflozin (25 mg) or a placebo. Cardiac magnetic resonance imaging was conducted at various stages of the study, and insulin resistance, sensitivity, and β-cell function were assessed through glucose and insulin values obtained from oral glucose tolerance tests (OGTT) and fasting C-peptide measurements.

After 7 months of treatment with empagliflozin, patients experienced a significant reduction in glucose and insulin values during the OGTT, though C-peptide, mannose levels, and HbA1c remained unchanged. The medication notably improved insulin sensitivity indexes, though it did not impact insulin resistance or β-cell function.

Upon discontinuation of the drug, all indexes reverted to their initial levels. Notably, insulin sensitivity indexes were found to be inversely correlated with left ventricular mass at baseline.

Fortin E, Lundin M, Mellbin L, et al. Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia : Experiences from the randomized, controlled SOCOGAMI trial. Cardiovasc Diabetol. 2023;22(1):208. doi: 10.1186/s12933-023-01950-0. PMID: 37568149; PMCID: PMC10422806.