Is empagliflozin better than glimepiride?

This study compared the safety and effectiveness of empagliflozin (Jardiance) with glimepiride (Amaryl) in people with type 2 diabetes (T2D). It was determined that empagliflozin reduced HbA1c more than glimepiride, and had a lower overall risk of side effects.

Metformin (Glucophage) is usually the first drug given to people with T2D. However, since T2D is a chronic condition, as it progresses more than one medication is often needed to control glucose levels. Sulfonylureas, such as glimepiride, are often the next medication given. Sulfonylureas lower blood glucose by stimulating the release of insulin. However, they are associated with side effects like weight gain and hypoglycemia (dangerously low blood glucose).

Empagliflozin is an SGLT2 inhibitor. SGLT2 inhibitors prevent glucose from re-entering the bloodstream from the kidneys. SGLT2 inhibitors may be more effective and safer than sulfonylureas, but the long-term effectiveness is still under investigation.

1,125 adults with T2D participated in this study. At the start of the study, their glucose levels were high despite treatment with metformin. They were randomly divided into two groups. 576 people received empagliflozin and 549 received glimepiride, in addition to metformin. They were followed up for 4 years.

HbA1c (average blood glucose over the last 3 months) was lower in both groups after 4 years. However, the average HbA1c level was 0.18% lower in the empagliflozin group than in the glimepiride group. After four years, the average fasting blood glucose level (blood glucose after a period without food or drink) was 11.8mg/dL lower in the empagliflozin group than the glimepiride group.

Some patients’ blood glucose levels were dangerously high, despite treatment, and they needed to be given additional ‘rescue’ medication (other types of glucose-lowering drugs). The empagliflozin group was 44% less likely to need rescue medication than the glimepiride group.

The empagliflozin group was more likely to lose weight, and the glimepiride group more likely to gain weight, with an average difference of 4.92kg between the two groups after 4 years. Blood pressure was reduced in the empagliflozin group, but tended to increase in the glimepiride group, after 4 years.

Overall, side effects were less common in the empagliflozin group. The empagliflozin group was 92% less likely to experience hypoglycemia than the glimepiride group. However, genital infections, urinary tract infections, and dehydration were more common in the empagliflozin group.

The study concluded that empagliflozin reduced HbA1c, with a lower risk of hypoglycemia and most other side effects, than glimepiride.

The manufacturers of empagliflozin funded this study.

Discuss the safety and effectiveness of SGLT2 inhibitors with your physician.