The beneficial effects of empagliflozin-metformin combination on cardiovascular risk factors in type 2 diabetes mellitus patients

Abstract

Type 2 diabetes mellitus (T2DM) is a multifactorial disease closely associated with increased cardiovascular risk, involving insulin resistance (IR), dyslipidemia, oxidative stress, and systemic inflammation. Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has shown cardiovascular benefits beyond glycemic control. This study aimed to evaluate the effects of Empagliflozin-Metformin combination on cardiovascular risk factors in T2DM patients. In this cross-sectional study, 124 participants were divided into three groups: healthy control group (n = 50), T2DM patients treated with metformin alone (Met group, n = 37), and T2DM patients treated with Empagliflozin-Metformin combination (Empa-Met group, n = 37). Serum levels of fasting blood glucose (FBG), HbA1c, lipid profile, insulin, hs-CRP, malondialdehyde (MDA), total antioxidant capacity (TAC), and free thiol groups (-SH) were measured. IR was assessed using the homeostatic model assessment (HOMA-IR), and cardiovascular risk was estimated using the atherogenic index of plasma (AIP) and lipid ratios. The Empa-Met group exhibited significantly higher FBG levels and lower levels of total cholesterol (TC), LDL-C, triglycerides (TG), insulin, LDL/HDL, TC/HDL ratios, and HOMA-IR compared to the Met group. The Empa-Met group also showed significantly higher -SH levels and lower MDA levels compared to the Met group. Correlation analyses revealed significant correlations between oxidative stress markers, IR, and atherogenic indices. Empagliflozin-Metformin combination therapy may offer additional benefits over metformin monotherapy in improving lipid parameters, IR, and oxidative stress in T2DM patients. These findings support the potential cardioprotective role of empagliflozin and highlight the need for long-term interventional studies to confirm our results.