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EMPA-REG OUTCOME examined empagliflozin in patients with type 2 diabetes and established cardiovascular disease. Compared with placebo, empagliflozin reduced cardiovascular death, hospitalization for heart failure and all-cause mortality. The magnitude and early separation of the curves helped establish SGLT2 inhibitors as cardiovascular risk-modifying therapies. For general physicians, the study is relevant when choosing glucose-lowering therapy for patients with high cardiovascular risk because the clinical goal extends beyond HbA1c. Empagliflozin's effects on heart-failure hospitalization and cardiovascular mortality also connect diabetes care directly with cardiology and nephrology. Safe prescribing requires attention to kidney function, volume status, genital infections and temporary discontinuation during acute illness. The major practice lesson is to phenotype the patient first: a person with established ASCVD, heart failure or CKD may benefit from a therapy selected partly for organ protection rather than glucose reduction alone. The trial helped establish the modern cardiometabolic approach to type 2 diabetes treatment.
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EMPA-REG OUTCOME examined empagliflozin in patients with type 2 diabetes and established cardiovascular disease. Compared with placebo, empagliflozin reduced cardiovascular death, hospitalization for heart failure and all-cause mortality. The magnitude and early separation of the curves helped establish SGLT2 inhibitors as cardiovascular risk-modifying therapies. For general physicians, the study is relevant when choosing glucose-lowering therapy for patients with high cardiovascular risk because the clinical goal extends beyond HbA1c. Empagliflozin's effects on heart-failure hospitalization and cardiovascular mortality also connect diabetes care directly with cardiology and nephrology. Safe prescribing requires attention to kidney function, volume status, genital infections and temporary discontinuation during acute illness. The major practice lesson is to phenotype the patient first: a person with established ASCVD, heart failure or CKD may benefit from a therapy selected partly for organ protection rather than glucose reduction alone. The trial helped establish the modern cardiometabolic approach to type 2 diabetes treatment.
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