Implications of the outcome of EMPA-REG outcome on type 2 diabetes mellitus management

Abstract

Diabetes has been implicated in micro-and macro-vascular complications. Glycaemic controls have been found to reduce the risk of microvascular complications in type 2 diabetes. However, studies suggest a possible relation between glycaemic control in decreasing macrovascular complications. The traditional approach of aggressive glycaemic management often leads to hypoglycaemia. Hypoglycaemia induces a series of physiological effects that increase cardiovascular disease risk (CVD). In fact, most of the hypoglycaemic agents such as thiazolidinediones, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter 2 (SGLT2) inhibitors have been approved based on their ability to decrease glycosylated haemoglobin A1c (HbA1c) rather than their ability to prevent CV morbidity and mortality. In the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients Removing Excess Glucose (EMPA-REG OUTCOME®) trial, Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, have been proven to exert a cardioprotective effect in type 2 diabetes patients. This paper discusses the outcome of EMPA-REG OUTCOME® and its implication in the management of type 2 diabetes patients that are at risk for CVD.