DOSE UP-TITRATION OF EMPAGLIFLOZIN AMONG TYPE 2 DM PATIENTS UNCONTROLLED ON EXISTING ORAL ANTIDIABETIC AGENTS

Abstract

INTRODUCTION
In most trials involving empagliflozin, the effect on HbA1c reduction was based on concurrent use of 2 doses of the drug without dose titration. This study aims to determine the proportion of patients who need to up-titrate empagliflozin from 10 mg to 25 mg to achieve the desired A1c reduction.

METHODOLOGY
T2DM patients uncontrolled on existing oral glucose-lowering drugs were given empagliflozin 10 mg daily for 3 months. Those who achieved a reduction in HbA1c more than 0.5% from baseline will continue the same dose for another 3 months while those those who had HbA1c reduction of 0.5% or less will be given 25 mg daily for 3 months.

RESULTS
A total of 55 (67.9%) patients had significant HbA1c reduction >0.5% after 3 months on 10 mg empagliflozin (non-titration group), while 26 (32.1%) patients required up-titration of empagliflozin to 25 mg daily for another 3 months (up-titration group). There was no further significant reduction in mean HbA1c from 7.50% (range: 7.1 to 8.15) to 7.45% (range: 6.78 to 8.13), p=0.574 after 3 months of 25 mg empagliflozin. At 3 months therapy with empagliflozin 10 mg, 55 (67.9%) patients achieved mean HbA1c reduction of >0.5% from baseline 7.8%(range: 7.5 to 8.7) to 6.95% (range: 6.53 to 7.38), p<0.001 and remains stable after the continuation for another 3 months.

CONCLUSION
Most patients responded well to 10 mg of empagliflozin and achieved sustained HbA1c at 6 months of treatment. However, a third of patients did not respond well to empagliflozin 10 mg, even after up-titrating to 25 mg. These finding suggests that if patients do not achieve at least 0.5% reduction in HbA1c with 10 mg dose, further significant reduction in HbA1c is unlikely to be achieved with up-titration to 25 mg for the next 3 months.