Does Using Empagliflozin Reduce Hospitalization for Heart Failure and Angina in People With Diabetes? A Systematic Review

Abstract

Background Current statistics show that there are over 422 million people with diabetes around the world, and these numbers are in continuous increase (Lin et al 2020). The presence of type 2 diabetes mellitus increases the incidence of cardiovascular diseases (Leon & Thomas 2015). There is an increase trend towards using SGLT2 (Sodium Glucose Cotransporter 2) inhibitors, including empagliflozin, in the treatment of people with diabetes as the have shown beneficial effects in improving glucose control and cardiovascular events.

Objectives To examine whether empagliflozin decreases hospitalizations for heart failure or unstable angina for people with type 2 diabetes mellitus (T2DM).

Selection method The included studies compared using empagliflozin, 25 mg/10 mg, with placebo, no treatment. Only randomized controlled trials selected. Participants were people ≥18 years old with type 2 diabetes mellitus.

Method The preferred method for conducting this systematic review was the Cochrane Handbook for Systematic Reviews (2022). The search for study was carried out through EMBASE database, PubMed, and Cochrane from 2014 to 2022. The search strategy was the PICO, (P) stands for Population, (I) Intervention, (C) Comparison, and (O) Outcome. The selected studies were assessed for quality using CASP (Critical Appraisal Skills Programme) tool. The risk of bias was also assessed using the Cochrane Risk of Bias tool (RoB2). The study search, the quality assessment and risk of bias examination all conducted by one author.

Main results Four studies were retrieved for this systematic review. The studies compared using empagliflozin, 25 mg or 10 mg, with placebo, no treatment. Hospitalizations for heart failure were significantly lower in intervention groups, there is no significant difference in all-cause hospitalization, and the as no significant difference in hospitalization for unstable angina between the two groups.

Conclusion Provided the notable control of diabetes status, using empagliflozin had an association with decreased hospitalization for heart failure and other cardiovascular diseases. A strong recommendation for using empagliflozin depending on the available data. The effects of empagliflozin on hospitalization for heart failure or unstable angina require more examination in the future.