Comparison of effects of Empagliflozin and Linagliptin on Renal function and Glycaemic control
Clinical Diabetes and Endocrinology Journal: Published: May 2022
Diabetes Mellitus (DM) is a debilitating metabolic disorder
characterized by impaired insulin function, leading to chronic hyperglycemia.
Diabetic nephropathy (DN) is one of the most common and
severe microvascular complications of DM, occurring in about 20–30% of diabetic
patients, which is typically defined as increased excretion of protein in the
urine.
One of the major consequences of DN is kidney failure,
leading to end-stage renal disease (ESRD), advanced cardiovascular disease, and
death. Even with extensive lifestyle and drug interventions, DN still accounts
for the majority of cases of ESRD and triple the risk of dying from it.
TAKE HOME MESSAGE:
This study aimed to compare the effects of Linagliptin and
Empagliflozin on renal function and glycaemic control in patients with type 2
DM.
Treatment of DN consists of different interventions,
including changes in lifestyle, glycaemic control, and pharmaceutical
treatments.
Poor glycaemic control is associated with more severe DN,
with glycaemic control can prevent the incidence of DN and slow its progression.
Glycemic control can also, in the long term, reverse some kidney histological
changes in patients with type 2 DM. Therefore, glycaemic control is one of the
cornerstones of type 2 DM treatment.
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are one of
the suggested pharmaceutical agents for glycaemic control in patients with
diabetes, and concurrent DN, especially those with an estimated glomerular
filtration rate (eGFR) of higher than 30 ml/min, high risk of
hospitalization due to heart failure or atherosclerotic cardiovascular diseases.
In addition to glycaemic control, SGLT2 inhibitors can prevent
glomerular injury. There are some hypotheses regarding the mechanisms of these
beneficial effects of SGLT2 inhibitors on renal function, including their
positive effects on risk factors of DN, reducing glomerular capillary pressure,
decreasing inflammation, activating renin-angiotensin system (RAS), and
decreasing podocyte damage; however, the exact mechanism is unknown.
Empagliflozin is a
SGLT2i that has anti-fibrotic and anti-inflammatory effects and can slow the
progression of DN.
Dipeptidyl peptidase-4 (DPP-4) inhibitors are another group
of medications used for glycaemic control and treatment of DN in patients with
type 2 DM.
DDP-4 enzymes are suggested to have roles in the progression
of kidney injury in patients with DN considering their inflammatory functions.
Therefore, inhibiting DDP-4 function is one of the therapeutic targets in
patients with DN; however, there are controversies regarding the effects of DDP-4
inhibitors on kidney injury in these patients.
Linagliptin is one of
the DDP-4 inhibitors which have been utilized for the treatment of DN.
In this double-blind, randomized clinical trial comparing the effectiveness of Empagliflozin and Linagliptin in patients with type 2 DM, Empagliflozin emerged superior in efficacy regarding reducing albuminuria in the short term follow up of 12 weeks, regardless of their pre interventional renal function, BMI, and HbA1C, which is in line with previous studies.
Conclusion
Regardless of baseline albuminuria, eGFR, or HbA1c,
Empagliflozin 10 mg daily significantly reduced albuminuria at
12 weeks compared to Linagliptin 5 mg daily in patients with type 2
diabetes.
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Background
This study aimed to compare the effects of Linagliptin and
Empagliflozin on renal function and glycaemic control in patients with type 2
diabetes mellitus (DM).
Method
We conducted a randomized, double-blind, parallel trial on
patients aged 30 to 80 years with type 2 DM and HbA1c ≤ 9%, regardless of
background medical therapy, to compare the effects of Empagliflozin and
Linagliptin on albuminuria, FBS, HbA1c, and eGFR. Participants were given the
mentioned drugs for 12 weeks. Statistical analysis was performed using
appropriate tests in IBM™SPSS® statistics software for windows version 24.
Results
In total, 60 patients participated in the study, thirty
patients in each group. The mean age of participants was 56.8 in the
Empagliflozin group and 60.9 in the Linagliptin group. Before the intervention,
FBS, HbA1C, and albuminuria values were significantly higher in the
Empagliflozin group than those in the Linagliptin group, but there was no
significant difference between groups regarding eGFR. Changes in the FBS,
HbA1C, and eGFR were not significantly different between groups, but there was
more decrease in albuminuria in the Empagliflozin group compared to the
Linagliptin group.
Conclusions
Regardless of baseline albuminuria, eGFR, or HbA1c,
Empagliflozin 10 mg daily significantly reduced albuminuria at 12 weeks
compared to Linagliptin 5 mg daily in patients with type 2 diabetes.
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