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Empagliflozin is an SGLT-2i with positive treatment outcomes in patients with T2DM and HF, though it was not originally developed for the combination of these conditions. Future long-term and well-designed clinical trials are needed to support these findings.

Type 2 diabetes mellitus (T2DM) and heart failure (HF) are the two of the most common medical conditions in older adults. The co-occurrence of these diseases leads to challenging clinical management and worsening of the prognosis of the affected individuals. The clinical condition of such patients is worse than that of HF patients without T2DM, with higher rates of cardiovascular and all-cause mortality.
The current general understanding is that T2DM does not influence the efficacy of HF treatments. Recently, hypoglycemic drugs have emerged as HF treatment. Sodium-glucose co-transporter-2 inhibitors (SGLT-2i) reduce cardiovascular events significantly. Empagliflozin is an SGLT2i that significantly reduces hospitalization in HF patients and can be considered in T2DM patients. This review, published in the International Journal of Medical Sciences, provides evidence and a thorough understanding of the therapeutic use of empagliflozin in T2DM and established HF patients.
Different clinical trials, including EMPA-REG OUTCOME, EMPEROR Reduced, EMPEROR Preserved, and EMPRISE, demonstrated the role of empagliflozin in reducing the risk of HF-related hospitalization. However, these clinical trials did not include patients with established HF and T2DM or a low degree of T2DM and HF. This depicts the insufficiency of evidence supporting the clinical applications of empagliflozin in HF and T2DM patients.
In patients suffering from HF with preserved ejection fraction (HFpEF) Empagliflozin was associated with rapid and short-term effects. This effect was attributed to the diuretic effect of empagliflozin. In contrast to loop diuretics, empagliflozin significantly increases 24-hour urine volume and does not elevate electrolyte-free water clearance and urinary sodium. Empagliflozin also decreased estimated plasma and extracellular volumes to a significant extent. A critical review of large clinical trials revealed that empagliflozin trials did not target patients with established HF and T2DM since the drug was not initially developed for this population.

Liang, B., & Gu, N. (2022). Empagliflozin in the treatment of heart failure and type 2 diabetes mellitus: Evidence from several large clinical trials. International Journal of Medical Sciences, 19(7), 1118-1121. https://doi.org/10.7150/ijms.72772

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