Empagliflozin and Arterial Stiffness in Patients with Type 2 Diabetes: A Real-World Case-Control Study

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated beneficial cardiovascular and renal effects in patients with type 2 diabetes mellitus (T2DM). Objective: The objective of this case-control study was to evaluate the efficacy of empagliflozin in modifying the arterial stiffness in type 2 diabetic patients. Methods: Pulse wave velocity (PWV) and other parameters of arterial stiffness were assessed at baseline and after three months of empagliflozin treatment in 16 consecutive outpatients with type 2 diabetes mellitus (T2DM) exhibiting normal left ventricular function and no signs of heart failure. A control group of 16 T2DM outpatients not treated with SGLT2 inhibitors was used for comparison. Results: Duration of diabetes mellitus and sex distribution did not differ between groups. Patients in the empagliflozin group were younger compared to controls (64.1 ± 8.68 vs 74.45 ± 8.13, p < 0.05). At 3-month follow-up, empagliflozin treatment significantly reduced HbA1c (7.9 ± 0.78 vs 7.04 ± 1.09%, p < 0.008). Empagliflozin significantly improved PWV compared to controls (from 13.2 ± 2.0 m/sec to 12.3 ± 1.8 m/sec; P = 0.001; in the control group 12.8 ± 2.3m/s to 13.2 ± 2.4, p = ns, with age and HbA1c as covariates) as well as body weight that significantly reduced (86.75 ± 16.16 kg vs 81.71 ± 16.5 kg, p =0.001) and BMI (30.48 ± 5.4 versus 28.75 ± 5.66 kg/m2, p < 0.002) in comparison to controls. Estimated glomerular filtration rate (eGFR) remained unchanged whereas a significant improvement of urine Albumin to Creatinine ratio with empagliflozin emerged (17.8 ± 46.8 vs 12.2 ± 35.7 mg/mmol, p = 0.049). Conclusion: In this clinical study, mid-term treatment with empagliflozin in patients with type 2 diabetes mellitus (T2DM) resulted in a significant reduction in arterial stiffness. Additionally, the improvement in the urine albumin-to-creatinine ratio suggests a potential enhancement in endothelial function.