Empagliflozin and Arterial Stiffness in Patients with Type 2 Diabetes: A Real-World Case-Control Study

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated beneficial cardiovascular and renal effects in patients with type 2 diabetes mellitus (T2DM).

The objective of this case-control study was to evaluate the efficacy of empagliflozin in modifying the arterial stiffness in type 2 diabetic patients.

Pulse wave velocity (PWV) and other parameters of arterial stiffness were assessed at baseline and after three months of empagliflozin treatment in 16 consecutive outpatients with type 2 diabetes mellitus (T2DM) exhibiting normal left ventricular function and no signs of heart failure. A control group of 16 T2DM outpatients not treated with SGLT2 inhibitors was used for comparison.

Duration of diabetes mellitus and sex distribution did not differ between groups. Patients in the empagliflozin group were younger compared to controls (64.1 ± 8.68 vs 74.45 ± 8.13, p < 0.05). At 3-month follow-up, empagliflozin treatment significantly reduced HbA1c (7.9 ± 0.78 vs 7.04 ± 1.09%, p < 0.008). Empagliflozin significantly improved PWV compared to controls (from 13.2 ± 2.0 m/sec to 12.3 ± 1.8 m/sec; P = 0.001; in the control group 12.8 ± 2.3m/s to 13.2 ± 2.4, p = ns, with age and HbA1c as covariates) as well as body weight that significantly reduced (86.75 ± 16.16 kg vs 81.71 ± 16.5 kg, p =0.001) and BMI (30.48 ± 5.4 versus 28.75 ± 5.66 kg/m2, p < 0.002) in comparison to controls. Estimated glomerular filtration rate (eGFR) remained unchanged whereas a significant improvement of urine Albumin to Creatinine ratio with empagliflozin emerged (17.8 ± 46.8 vs 12.2 ± 35.7 mg/mmol, p = 0.049).

In this clinical study, mid-term treatment with empagliflozin in patients with type 2 diabetes mellitus (T2DM) resulted in a significant reduction in arterial stiffness. Additionally, the improvement in the urine albumin-to-creatinine ratio suggests a potential enhancement in endothelial function.