The online version of this article (https://doi.org/10.1007/s00125-018-4702-3) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
In addition to beneficial effects on glycaemia and cardiovascular death, empagliflozin improves adiposity indices. We investigated the effect of empagliflozin on aminotransferases (correlates of liver fat) in individuals with type 2 diabetes.
Changes from baseline alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were assessed in the EMPA-REG OUTCOME® trial (n = 7020), pooled data from four 24-week placebo-controlled trials (n = 2477) and a trial of empagliflozin vs glimepiride over 104 weeks (n = 1545). Analyses were performed using data from all participants and by tertiles of baseline aminotransferases.
In the EMPA-REG OUTCOME® trial, mean ± SE changes from baseline ALT at week 28 were −2.96 ± 0.18 and −0.73 ± 0.25 U/l with empagliflozin and placebo, respectively (adjusted mean difference: −2.22 [95% CI −2.83, −1.62]; p < 0.0001). Reductions in ALT were greatest in the highest ALT tertile (placebo-adjusted mean difference at week 28: −4.36 U/l [95% CI −5.51, −3.21]; p < 0.0001). The adjusted mean difference in change in ALT was −3.15 U/l (95% CI −4.11, −2.18) with empagliflozin vs placebo at week 24 in pooled 24-week data, and −4.88 U/l (95% CI −6.68, −3.09) with empagliflozin vs glimepiride at week 28. ALT reductions were largely independent of changes in weight or HbA1c. AST changes showed similar patterns to ALT, but the reductions were considerably lower.
These highly consistent results suggest that empagliflozin reduces aminotransferases in individuals with type 2 diabetes, in a pattern (reductions in ALT>AST) that is potentially consistent with a reduction in liver fat, especially when ALT levels are high.
ESM Figures (PDF 236 kb)125_2018_4702_MOESM1_ESM.pdf
Dai W, Ye L, Liu A et al (2017) Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis. Medicine (Baltimore) 96:e8179 CrossRef
Forlani G, Di BP, Mannucci E et al (2008) Prevalence of elevated liver enzymes in type 2 diabetes mellitus and its association with the metabolic syndrome. J Endocrinol Investig 31:146–152 CrossRef
American Diabetes Association (2017) Comprehensive medical evaluation and assessment of comorbidities. Diabetes Care 40(Suppl 1):S25–S32 CrossRef
Rosenstock J, Jelaska A, Frappin G et al (2014) Improved glucose control with weight loss, lower insulin doses and no increased hypoglycemia with empagliflozin added-on to titrated multiple daily injections of insulin in obese inadequately controlled patients with type 2 diabetes. Diabetes Care 37:1815–1823 CrossRefPubMed
Rosenstock J, Jelaska A, Zeller C, Kim G, Broedl UC, Woerle HJ (2015) Impact of empagliflozin added-on to basal insulin in type 2 diabetes inadequately controlled on basal insulin: a 78-week randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 17:936–948 CrossRefPubMedPubMedCentral
Jojima T, Tomotsune T, Iijima T, Akimoto K, Suzuki K, Aso Y (2016) Empagliflozin (an SGLT2 inhibitor), alone or in combination with linagliptin (a DPP-4 inhibitor), prevents steatohepatitis in a novel mouse model of non-alcoholic steatohepatitis and diabetes. Diabetol Metab Syndr 8:45 CrossRefPubMedPubMedCentral
Tobita H, Sato S, Miyake T, Ishihara S, Kinoshita Y (2017) Effects of dapagliflozin on body composition and liver tests in patients with nonalcoholic steatohepatitis associated with type 2 diabetes mellitus: a prospective, open-label, uncontrolled study. Curr Ther Res Clin Exp 87:13–19 CrossRefPubMedPubMedCentral
Boehringer Ingelheim (2017) Empagliflozin (Jardiance®) to be studied in chronic kidney disease. Available from www.boehringer-ingelheim.com/press-release/empagliflozin-be-studied-chronic-kidney-disease. Accessed 10 Jan 2018
- Empagliflozin is associated with improvements in liver enzymes potentially consistent with reductions in liver fat: results from randomised trials including the EMPA-REG OUTCOME® trial
Jyothis T. George
- Springer Berlin Heidelberg
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II