Efficacy and safety of empagliflozin in patients over 65 with type 2 diabetes mellitus complicating cardiorenal syndromes type II and IV.

Abstract

Background: Cardiorenal syndrome (CRS) is a complex clinical condition that leads to deterioration in both cardiac and renal functions. Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is a novel anti-diabetic drug that also improves cardiac and renal functions. However, little research exists on the efficacy and safety of empagliflozin in elderly type 2 diabetes mellitus (T2DM) patients with CRS. We aimed to evaluate the effectiveness and safety of empagliflozin in patients 65 and older with T2DM complicated by Type II and IV CRS.

Methods: A randomised, prospective study was conducted involving 200 patients 65 and older diagnosed with T2DM and CRS who were admitted to the cardiovascular department of Fujian Provincial Governmental Hospital from January 2020 to January 2024. Patients were randomised into an experimental group (n=100) treated with empagliflozin 10mg/day and a control group (n=100) receiving standard care. Blood glucose, cardiac and renal function indicators, adverse reactions and major adverse cardiovascular events were compared between groups. T-tests, Mann-Whitney U tests, Wilcoxon signed-rank tests, and chi-square tests were performed appropriately.

Results: After one-year follow-up, patients in the experimental group showed significant improvements in fasting blood glucose, glycated haemoglobin, serum creatinine, urinary microalbumin, NT-proBNP, left ventricular ejection fraction, and left ventricular end-diastolic diameter compared to the control group (P<0.05). Empagliflozin also reduced the incidence of major adverse cardiovascular events, with a non-significant increase in adverse reactions such as urinary tract infections and genital infections.

Conclusions: Empagliflozin demonstrates efficacy in improving glycemic control and cardiorenal function in T2DM patients over 65 with CRS. However, the drug's effect on biomarkers of acute myocardial injury and thrombosis requires further investigation. This study contributes to the growing body of evidence supporting the use of SGLT2 inhibitors in the management of CRS and emphasises the need for larger-scale, long-term studies to confirm these findings.