Green Is Life

Diabetes Care That Reduces Weight and Extends Life

A remarkable study was published in the New England Journal of Medicine this week, demonstrating that type 2 diabetes care with an SGLT2 inhibitor (empagliflozin) both reduces weight and extends life. Of course, the most remarkable part of the study is the survival benefit that empaglifozin provides.

In a randomized, placebo-controlled trial over just three years, the study showed a 32% reduction in death from any cause, a 38% reduction in risk of death from heart disease, and a 35% reduction in hospitalization for heart failure. Cleveland Clinic’s chair of cardiovascular medicine, Steven Nissen, explained just how remarkable these results were:

There are very few therapies we have in cardiovascular medicine that have ever shown a one-third reduction in the risk of cardiovascular death. Reducing that rate by 38% is a landmark result.

Impact of Empagliflozin on WeightIt’s worth thinking a bit about the fact that this is a diabetes drug that has the useful side effect of a very modest reduction in weight. In this study, the mean reduction in weight was just a little more than 2% — not enough to meet FDA’s threshold for approving a drug to treat obesity.

It’s also noteworthy that not too many years ago, doctors were widely prescribing drugs like Avandia (rosiglitazone) for type 2 diabetes, despite the fact that they were well-understood to cause weight gain. Widespread use of Avandia came to an end when the same person who is praising the empagliflozin study, Steven Nissen, spoke out forcefully about the potential for Avandia to increase the risk of heart failure and deaths from heart disease.

More and more, the management of type 2 diabetes goes hand in hand with the management of obesity when a patient has both of these diseases. The standard of care for people with obesity is very clearly defined in new guidelines from the Endocrine Society to first do no harm — that is to avoid prescribing drugs in a way that will lead to weight gain.

It’s no coincidence that liraglutide — a well-established treatment for diabetes with an indication at a higher dose for obesity — is finding some success on a path of gradual uptake for obesity in the form of Saxenda. It’s already quite successful for type 2 diabetes under the brand name of Victoza.

The finding that empagliflozin can deliver such impressive outcomes for diabetes, with a modest bit of weight loss on the side, is good news indeed.

Click here to read more from the New York Times and here to read the study.

Green Is Life, photograph © Vasile Hurghis / flickr

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September 19, 2015