How EMPA-REG Has Changed My Practice

Today I am going to discuss the results of the EMPA-REG trial.^[1] More importantly, I am going to talk about how they have changed my clinical practice. Just to review, for those of you who don't know the results or remember them, the EMPA-REG trial was one of the many cardiovascular outcomes trials that we did with new diabetes drugs. This particular cardiovascular outcomes trial compared the sodium glucose cotransporter 2 (SGLT2) inhibitor known as empagliflozin with placebo in patients with established cardiovascular disease. It was a big multicenter trial, and the results were released in Stockholm at the European Association for the Study of Diabetes meeting.

I can tell you that I have been in the audience at many diabetes meetings, and people are usually relatively unimpressed. When the results from EMPA-REG came up on the screen, not only did 5000 diabetologists gasp, we also cheered and applauded. Why was that? It was because this is the first time that we've had a diabetes drug that reduces the relative risk for both cardiovascular and all-cause mortality. This was staggering news to us because we have been plodding along, keeping glycated hemoglobinlevels under control, and preventing microvascular complications from diabetes, but our patients remained at high risk for macrovascular disease.