GLYCEMIC CONTROL AND BODY WEIGHT EFFECTS OF 25 MG FULL TABLET VERSUS 12.5 MG HALF TABLET EMPAGLIFLOZIN IN THE TREATMENT OF TYPE 2 DIABETES (T2D)

A SINGLE CENTRE EXPERIENCE

Abstract

INTRODUCTION
Empagliflozin is the most commonly available sodiumglucose co-transporter-2 (SGLT2) inhibitor in government hospitals. Benefits of empagliflozin has been proven in randomized controlled trials and adopted into international and local T2D practice guidelines. However, prescription of empagliflozin is still limited by cost. Although halving the tablet of empagliflozin is not recommended, there is no clear evidence against this practice. We aimed to compare the effect of full-tablet empagliflozin (25 mg) and halftablet empagliflozin (12.5 mg) in the treatment of patients with T2D.

METHODOLOGY
This is a cross-sectional study conducted in Hospital Sultan Haji Ahmad Shah (HoSHAS). Prior to 2019, patients with T2D in HoSHAS have been prescribed with full-tablet empagliflozin (25 mg) while after 2019, new patients have been initiated with half-tablet empagliflozin (12.5 mg) due to limited resources. All actively treated patients were included in the study. Electronic medical records were reviewed for patient demographic and clinical parameters such as HbA1c, body weight and insulin treatment at treatment initiation and latest follow-up.

RESULTS
66 patients were on active empagliflozin treatment, with mean age of 50.36 years old and diabetes duration of 10.8 years. Almost two-thirds of the patients were male and treated with half-tablet empagliflozin (12.5 mg). The mean duration of SGLT2 treatment was 10.9 months. Full-tablet (25 mg) vs. half-tablet (12.5 mg) empagliflozin treatment did not show any significant difference in HbA1c reduction (1.10% vs 0.91%, p=0.724) and weight reduction (3.38 kg vs 2.27 kg, p=0.595). 43.7% of patients were on concomitant insulin treatment. 15.2% of patients had reduction in total insulin daily dose. 4.5% of patients were able to discontinue insulin. Full-tablet and half-tablet empagliflozin had comparable effects on insulin dose reductions.

CONCLUSION
This study suggested that the unconventional practice of using half tablet of empagliflozin had comparable results to full-tablet treatment and can be an option in management of T2D where there are limited resources.