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RECENT PUBLICATIONS ON RESIDUAL RISK

2017

Empagliflozin decreases remnant cholesterol in diabetes patients

Empagliflozin, a potent and highly selective sodium-glucose co-transporter-2 (SGLT-2) inhibitor of the proximal tubule, has previously been shown to significantly reduce major adverse cardiovascular events and mortality in patients with type 2 diabetes from the EMPA-REG OUTCOME study (1). The mechanisms behind these rapid-onset benefits, are likely to be multifactorial, possibly involving favourable effects on insulin sensitivity. This study investigated whether treatment effects on remnant cholesterol are associated with a change in insulin resistance in patients with type 2 diabetes.
 
In total 109 type 2 diabetes patients were allocated to treatment with empagliflozin (n=58) or placebo (n=51) for 12 weeks. Blood glucose and lipid control were similar in both groups at baseline. Treatment with empagliflozin led to significant decreases in HbA1c, body weight, systolic blood pressure, plasma triglycerides, liver transaminases and estimated glomerular filtration rate, and also increased high-density lipoprotein cholesterol. Empagliflozin was also associated with decreases in remnant cholesterol and HOMA-R. In multiple regression analysis, the change in HOMA-R was significantly associated with the change in remnant cholesterol in the empagliflozin group (p=0.00241).
 
In conclusion, this study shows that empagliflozin decreased remnant cholesterol and that this was associated with amelioration of insulin sensitivity in patients with type 2 diabetes. Although confirmation is needed in larger studies, these findings provide a possible (part) explanation for the cardiovascular benefit of empagliflozin in patients with diabetes.
Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.

Zinman B, Wanner C, Lachin JM, et al.