Italy: SGLT2 Inhibitor Empagliflozin Study

The SGLT2 inhibitor empagliflozin improves cognitive and physical impairment in frail older adults with type 2 diabetes and heart failure with preserved ejection fraction (HFpEF), a recent study has found. The study was published in the journal Diabetes Care on March 21, 2022.

Previous studies have shown that frail patients with diabetes and HFpEF have a higher risk of cognitive and physical impairment. Empagliflozin is an SGLT2 inhibitor that is part of the newest class of oral hypoglycemic agents, which includes dapagliflozin and canagliflozin.

Study Design

The prospective study was designed by Pasquale Mone, Azienda Sanitaria Locale Avellino, Avellino, Italy, and colleagues with an aim to assess whether the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin improves cognitive impairment in frail older adults with diabetes and HFpEF, comparing the effects of metformin, empagliflozin, and insulin.

The study was successfully completed by a total of 162 frail older adults with HFpEF and diabetes.

Key Findings

• Montreal Cognitive Assessment scores at baseline and after 1 month were 19.80 ± 3.77 vs. 22.25 ± 3.27 in the empagliflozin group, 19.95 ± 3.81 vs. 20.71 ± 3.56 in the metformin group, and 19.00 ± 3.71 vs. 19.1 ± 3.56 in the insulin group.
• A multivariable regression analysis confirmed the beneficial effects of empagliflozin.
• A marked amelioration of physical impairment was observed, assessed by the 5-m gait speed test, in the empagliflozin and metformin groups but not in the insulin group.

"This study is the first to show significant beneficial effects of the SGLT2 inhibitor empagliflozin on cognitive and physical impairment in frail older adults with diabetes and HFpEF," concluded the authors.

Limitations

Limitations to the study include no control arm — scores were compared with individuals on insulin and/or metformin; additionally, the follow-up period was only 1 month since starting therapy.

Reference

Pasquale Mone, Angela Lombardi, Jessica Gambardella, Antonella Pansini, Gaetano Macina, Maria Morgante, Salvatore Frullone, Gaetano Santulli; Empagliflozin Improves Cognitive Impairment in Frail Older Adults With Type 2 Diabetes and Heart Failure With Preserved Ejection Fraction. Diabetes Care 2022; dc212434. https://doi.org/10.2337/dc21-2434