From the Guidelines
For a new diabetic patient with no comorbidities, empagliflozin is the more effective option compared to dapagliflozin, due to its slightly stronger cardiovascular outcome data in clinical trials, as demonstrated in the EMPA-REG OUTCOME trial 1. When considering the treatment options for a new diabetic patient with no comorbidities, it is essential to evaluate the efficacy and safety of different medications. Both empagliflozin and dapagliflozin are SGLT2 inhibitors that have shown promise in reducing blood glucose levels and improving cardiovascular outcomes. However, the EMPA-REG OUTCOME trial 1 demonstrated that empagliflozin reduced the composite outcome of MI, stroke, and cardiovascular death by 14% and cardiovascular death by 38%, which suggests a slightly stronger cardiovascular benefit compared to dapagliflozin.
Key Considerations
- Empagliflozin and dapagliflozin have similar mechanisms of action, preventing glucose reabsorption in the kidneys and increasing glucose excretion in urine.
- Both medications have comparable side effect profiles, with genital mycotic infections, urinary tract infections, and volume depletion being the most common.
- The DAPA-CKD trial 1 showed that dapagliflozin reduced the risk of the primary composite outcome of sustained decline in eGFR, end-stage kidney disease, or death from renal or cardiovascular causes by 39%, which is a significant benefit, but the EMPA-REG OUTCOME trial 1 provides more direct evidence for cardiovascular outcomes.
- A more recent study 1 confirmed the benefits of SGLT2 inhibitors in preventing heart failure hospitalizations, but empagliflozin's stronger cardiovascular outcome data make it a more effective option for new diabetic patients with no comorbidities.
Treatment Recommendations
- Empagliflozin is typically started at 10mg once daily and can be increased to 25mg if needed.
- Dapagliflozin is usually prescribed at 5mg or 10mg once daily.
- Patients should be advised about proper genital hygiene and adequate hydration to minimize side effects.
- The choice between empagliflozin and dapagliflozin may ultimately depend on insurance coverage, cost considerations, and patient-specific factors, but empagliflozin's slightly stronger cardiovascular outcome data make it the more effective option 1.
From the Research
Efficacy Comparison
- Empagliflozin and dapagliflozin are both sodium-glucose co-transporter 2 (SGLT2) inhibitors used in the treatment of type 2 diabetes mellitus (T2DM) 2, 3.
- A 3-year prospective observational study found that empagliflozin performed better than dapagliflozin in terms of HbA1c reduction, fasting plasma glucose reduction, and body weight reduction 4.
- A randomized controlled trial found that empagliflozin caused a significant reduction in fasting blood sugar and HbA1c as compared to dapagliflozin 5.
Cardiovascular Outcomes
- A nationwide population-based cohort study found that the risk of composite cardiovascular outcomes was not significantly different between dapagliflozin and empagliflozin users 6.
- However, dapagliflozin might be associated with lower risks of hospitalization or death due to heart failure and cardiovascular death than empagliflozin in Asian patients with T2DM 6.
- Empagliflozin has been shown to reduce cardiovascular mortality and all-cause mortality in patients with established cardiovascular disease and T2DM 2.
Safety Profile
- Both empagliflozin and dapagliflozin have been found to have a good safety profile, with no major adverse effects reported in clinical trials 4, 5.
- However, empagliflozin has been found to have a lower risk of urinary and genital infection compared to dapagliflozin 5.
- The overall incidence of adverse events, cardiovascular events, and mortality did not differ between the two groups in a 3-year prospective observational study 4.