Type 2 diabetes mellitus (T2DM) management is complex, with few patients successfully achieving recommended glycemic targets with monotherapy, most progressing to combination
therapy, and many eventually requiring
insulin.
Sodium glucose cotransporter 2 (
SGLT2) inhibitors are an emerging class of antidiabetes agents with an
insulin-independent mechanism of action, making them suitable for use in combination with any other class of antidiabetes agents, including
insulin. This review evaluates a 78-week, randomized, double-blind, placebo-controlled trial investigating the impact of
empagliflozin, an
SGLT2 inhibitor, as add-on to basal
insulin in patients with inadequate
glycemic control on basal
insulin, with or without
metformin and/or a sulfonylurea.
Empagliflozin added on to basal
insulin resulted in significant and sustained reductions in
glycated hemoglobin (HbA1c) levels compared with placebo.
Empagliflozin has previously been shown to induce
weight loss, and was associated with sustained
weight loss in this study. This combination
therapy was well tolerated, with similar levels of
hypoglycemic adverse events in the
empagliflozin and placebo groups over the 78-week treatment period.
Urinary tract infections and genital
infections, side effects associated with
SGLT2 inhibitors, were reported more commonly in the
empagliflozin group; however, such events led to treatment discontinuation in very few patients. These findings suggest that, with their complementary mechanisms of action,
empagliflozin added on to basal
insulin may be a useful treatment option in patients on basal
insulin who need additional
glycemic control without
weight gain.