The effect of empagliflozin on the gut microbiome and cardiovascular health
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on December 7th, 2022
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Metformin is recommended as the first-line antihyperglycemic agent in most clinical guidelines, including the one published by the World Health Organization. In the United States, empagliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i), is recommended by the Food and Drug Administration due to its cardiovascular benefit. A recently published study had investigated the health effect between patients metformin and empagliflozin.
The clinical trial included 76 adults between the age of 18 and 75 years old. These patients had been diagnosed with type 2 diabetes and have a Hb1Ac level between 6.5% and 13%, but they have not been treated with any antihyperglycemic medications. In addition, patients enrolled in this trial might have one of the following attributes indicating an increased risk of cardiovascular diseases: hypertension, obesity (BMI > 28 kg/m2), hypertriglyceridemia (above 2.3 mmol/L), and hypercholesterolemia (LDL cholesterol above 2.6 mmol/L), among others. The patients were randomly assigned into 2 treatment groups that lasted 3 weeks long: 1) 10 mg of empagliflozin per day; 2) 1700 mg of metformin per day. The study reported that empagliflozin is as effective as metformin in glycemic control; as both groups experience the same degree of improvement in weight loss, waist circumference reduction, decreased in Hb1Ac level and multiple biomarkers indicating systemic inflammation. However, only the SGLT2i improves the patient’s cardiovascular health; as those in the empagliflozin experience a significant reduction in blood pressure and increase in hematocrit. Plasma metabolites analysis found that empagliflozin helped increase the concentration of sphingomyelin and decrease the serum level of uric acid and glycochenodeoxycholate. These improved clinical outcomes can potentially be explained by empagliflozin interaction with the gut microbiome. Since, the microbiota of those taking empagliflozin is enriched with bacteria capable of producing beneficial short-chain fatty acids such as those in the Roseburia, Eubacterium, and Faecalibacterium species. Future studies need to be conducted to long-term effect of empagliflozin on the gut microbiota and in the prevalence of cardiovascular accidents.
The clinical trial included 76 adults between the age of 18 and 75 years old. These patients had been diagnosed with type 2 diabetes and have a Hb1Ac level between 6.5% and 13%, but they have not been treated with any antihyperglycemic medications. In addition, patients enrolled in this trial might have one of the following attributes indicating an increased risk of cardiovascular diseases: hypertension, obesity (BMI > 28 kg/m2), hypertriglyceridemia (above 2.3 mmol/L), and hypercholesterolemia (LDL cholesterol above 2.6 mmol/L), among others. The patients were randomly assigned into 2 treatment groups that lasted 3 weeks long: 1) 10 mg of empagliflozin per day; 2) 1700 mg of metformin per day. The study reported that empagliflozin is as effective as metformin in glycemic control; as both groups experience the same degree of improvement in weight loss, waist circumference reduction, decreased in Hb1Ac level and multiple biomarkers indicating systemic inflammation. However, only the SGLT2i improves the patient’s cardiovascular health; as those in the empagliflozin experience a significant reduction in blood pressure and increase in hematocrit. Plasma metabolites analysis found that empagliflozin helped increase the concentration of sphingomyelin and decrease the serum level of uric acid and glycochenodeoxycholate. These improved clinical outcomes can potentially be explained by empagliflozin interaction with the gut microbiome. Since, the microbiota of those taking empagliflozin is enriched with bacteria capable of producing beneficial short-chain fatty acids such as those in the Roseburia, Eubacterium, and Faecalibacterium species. Future studies need to be conducted to long-term effect of empagliflozin on the gut microbiota and in the prevalence of cardiovascular accidents.