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Empagliflozin is a medication used in the management and treatment of type 2 diabetes mellitus. It is in the sodium-glucose co-transporter (SGLT-2) class of medication for diabetes. This activity describes the indications, action, and contraindications for empagliflozin as a valuable agent in treating type 2 diabetes mellitus. This activity will highlight the mechanism of action, dosing, monitoring pertinent for members of the interprofessional team in the management of patients with type 2 diabetes. Objectives: Identify indications for initiating empagliflozin therapy. Outline the contraindications for empagliflozin therapy. Describe common and uncommon adverse effects of empagliflozin therapy. Review interprofessional strategies that will improve outcomes when prescribing/ordering empagliflozin therapy. Access free multiple choice questions on this topic.

The most commonly reported side effects were urinary tract infections, genital mycotic infections, and dyslipidemia. Due to its diuretic properties related to volume depletion, there were also reports of dehydration, hypotension, hypovolemia, and syncope. The FDA issued a warning for Fournier gangrene, a type of necrotizing fasciitis of the perineum. There were twelve reported cases, and all twelve were hospitalized, requiring surgical debridement. If suspected, stop the drug and have the patient report to the ED promptly for a surgical evaluation.[5][6]

The landmark trial for empagliflozin is called the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes mellitus patients (EMPA REG OUTCOME), which pooled a total of 7020 patients and found significantly lower rates of death from cardiovascular causes, hospitalizations for heart failure, and death from any co-transporter in the empagliflozin group.[7] This trial was the first of its kind to show a reduction in cardiovascular mortality in patients with type 2 diabetes and cardiovascular risk. Due to findings in the EMPA REG and LEADER trial, societies now favor SGLT2 inhibitors and GLP 1 agonists as second-line therapy over insulin, depending on patient characteristics. According to the Efficacy and Durability of Initial Combination (EDICT) for Type 2 diabetes trial, triple dose combination therapy of metformin, SGLT 2 inhibitor, and pioglitazone in patients with newly diagnosed type 2 diabetes had a more significant reduction in HbA1c levels than patients who sequentially added on therapy with medications.[8] The entire interprofessional healthcare team should participate in empagliflozin therapy. The family clinician or endocrinologist will make the initial prescribing decision. Nursing should understand the adverse event profile of this drug, and assist in monitoring at follow-up visits, for both side effects as well as therapeutic effectiveness. The pharmacist should weigh in with dosing verification, suggestions on dosing titration, and performing medication reconciliation to prevent drug interactions, and can suggest other agents if additional glucose control is necessary. These various disciplines collaborating as a cohesive interprofessional unit will optimize therapy with empagliflozin while minimizing risks. [Level 5]