A comprehensive literature review published in Diabetology & Metabolic Syndrome reports that empagliflozin extends beyond glucose lowering to reduce cardiorenal morbidity and mortality in patients with or without diabetes. Formulated from an Egyptian expert perspective within a global clinical context, the review evaluates the drug’s clinical efficacy, overall safety profile, and cost-effectiveness in the Egyptian population. The authors framed their assessment around the expanding therapeutic indications of empagliflozin beyond conventional glycemic control, evaluating its role against the growing burden of cardiometabolic diseases. By synthesizing international evidence alongside national healthcare considerations, the review provides an expert appraisal of how this therapeutic agent addresses interconnected cardiorenal and metabolic conditions across diverse clinical populations.
To conduct the comprehensive evaluation, the investigators performed a structured literature review across the PubMed and Google Scholar electronic databases. The search methodology identified relevant clinical trials, systematic reviews, meta-analyses, and clinical practice guidelines published in the English language up to July 2025. The authors included studies reporting on empagliflozin’s pharmacological profile, its biological mechanisms of action, and its documented clinical outcomes across diabetes mellitus, cardiometabolic diseases, and renal and hepatic functions. Furthermore, the search criteria captured published literature evaluating patient safety and hypoglycemia risk during Ramadan fasting, as well as health-economic analyses addressing the cost-effectiveness of treatment regimens.
In the domain of glycemic control, the review documents that empagliflozin improves blood glucose management in patients with type 2 diabetes when administered either as a monotherapy or as part of combination therapy. The medication achieves this glycemic improvement through the targeted inhibition of sodium–glucose co-transporter-2, commonly designated as SGLT-2. In contrast, the authors highlight an important distinction regarding type 1 diabetes mellitus. Although clinical trials demonstrate that empagliflozin improves glycemic control as an adjunct therapy in type 1 diabetes, it is not recommended for this patient population because of an increased risk of diabetic ketoacidosis.
Beyond glucose regulation, the review highlights substantial cardiorenal protective effects established across the reviewed clinical evidence. Empagliflozin reduces major cardiovascular events, decreases hospitalizations for heart failure, and slows the progression of chronic kidney disease. Notably, these clinical risk reductions are observed in patients with diabetes as well as in individuals without diabetes. In addition to these primary cardiorenal endpoints, the analysis reports that treatment with empagliflozin produces modest weight loss and modest reductions in blood pressure, providing further therapeutic benefits across the spectrum of cardiometabolic disease management.
Regarding safety and tolerability, the review reports that empagliflozin demonstrates a favorable safety profile and a low risk of hypoglycemia during Ramadan fasting. The authors emphasize that this documented tolerability during fasting supports the medication’s suitability for the large Muslim population in Egypt and globally. In addition to establishing safety during fasting periods, the synthesized evidence indicates that empagliflozin treatment enhances patients’ overall quality of life. Furthermore, economic evaluations evaluated in the literature review characterize empagliflozin as a cost-effective therapeutic intervention across evaluated patient groups.
The review also addressed hepatic outcomes and identified critical priorities for future medical research. Emerging evidence indicates potential therapeutic benefits of empagliflozin in metabolic dysfunction-associated steatotic liver disease, commonly known as MASLD, although the drug is currently not approved for this clinical indication. Concluding their evaluation, the authors state that further research should evaluate the specific therapeutic role of empagliflozin in MASLD management. Additionally, they emphasize the necessity for future investigative studies to assess the drug’s cost-effectiveness specifically within the Egyptian healthcare setting.
Subject of Research: Empagliflozin efficacy, safety, and cardiorenal outcomes in cardiometabolic disease
Article Title: Empagliflozin’s role in cardiometabolic disease treatment: an Egyptian expert’s view
Article References: Assaad-Khalil, S. H., Elmessallamy, F., Elhadidy, K. E., El Hefnawy, M. H., Halawa, M. R., Zeitoun, M., Hussein, S., & Elebrashy, I. (2026). Empagliflozin’s role in cardiometabolic disease treatment: an Egyptian expert’s view. Diabetology & Metabolic Syndrome, 18(1), Article 228. https://doi.org/10.1186/s13098-026-02312-y
Image Credits: AI Generated
DOI: 10.1186/s13098-026-02312-y
Keywords: empagliflozin, type 2 diabetes, cardiometabolic disease, SGLT-2 inhibitors, heart failure, chronic kidney disease, Ramadan fasting, MASLD, role, cardiometabolic, disease, treatment
