Guideline change could save thousands more lives a year

A new study suggests that the wider use of SGLT2 inhibitors could save thousands of lives annually. Using primary care data, investigators demonstrated the mortality benefit of empagliflozin in people with type 2 diabetes in routine care. Previously, this effect had only been recorded in trial participants who met strict inclusion criteria.

Since 2022, NICE has recommended metformin and SGLT2 inhibitors as first-line treatment for many people with type 2 diabetes, including those at high risk of cardiovascular disease. This guidance was extrapolated from evidence from randomised controlled trials, such as EMPA-REG, which demonstrated that SGLT2 inhibitors have significant cardioprotective and mortality benefits. However, evidence from broader populations has been lacking.

Using a trial emulation based on EMPA-REG, researchers used UK primary care records to explore the effect of empagliflozin in a more clinically relevant population. The study included a total of 62,503 adults with type 2 diabetes initiating empagliflozin or a DPP-4 inhibitor (as control) between 1 January 2014 and 31 December 2022. Notably, 83.2% of those prescribed empagliflozin would not have met the EMPA-REG eligibility criteria.

During a median follow-up of 3.1 years, all-cause mortality was 24% less likely in those prescribed empagliflozin than those in the control group. This equates to one life being saved for every 47 people treated with empagliflozin over 3 years. With an estimated 3 million people receiving treatment for type 2 diabetes in the UK, the findings suggest that around 20,000 deaths could be prevented each year.

The investigators, from University College London and the London School of Hygiene and Tropical Medicine, conclude that their findings support the proposed NICE guidance to broaden the use of SGLT2 inhibitors in the management of type 2 diabetes.

The full study, published in BMJ Open Diabetes Research & Care, can be read here.