Publication:

Association of empagliflozin treatment with changes in the metabolic score for insulin resistance in Iraqi adults with type 2 diabetes: a 6-month prospective cohort study

Background The metabolic score for insulin resistance (METS-IR) is an insulin-free surrogate that combines fasting plasma glucose, triglycerides, body mass index, and high-density lipoprotein cholesterol. Evidence on its responsiveness to sodium-glucose cotransporter 2 (SGLT2) inhibition is limited.

Methods In this 6-month prospective observational cohort study, 124 adults with type 2 diabetes were enrolled at Al-Yarmouk Teaching Hospital, Baghdad. Empagliflozin 10 mg/day was added to usual oral therapy in 62 patients according to routine prescribing and patient preference; 62 continued therapies without an SGLT2 inhibitor or glucagon-like peptide-1 receptor agonist. Complete-case analyses included 58 and 56 participants, respectively. The primary outcome was the between-group difference in change in METS-IR.

Results At 6 months, mean METS-IR decreased from 48.6±6.2 to 42.8±5.8 in the empagliflozin group and from 49.1±6.5 to 48.5±6.4 in controls. The reported adjusted between-group difference was −5.42 points (95% CI −6.81 to −4.03; p<0.001). Empagliflozin exposure was also associated with larger reductions in HbA1c, body weight, body mass index, and triglycerides and a larger increase in HDL cholesterol. Within the empagliflozin group, change in METS-IR correlated with changes in HbA1c (r=0.48), triglycerides (r=0.41), and body mass index (r=0.35), but not fasting plasma glucose (r=0.18).

Conclusions Empagliflozin initiation was associated with a clinically and statistically larger reduction in METS-IR over 6 months than continued non-SGLT2 therapy. Because METS-IR contains several treatment-responsive components and treatment allocation was nonrandom, the findings should be interpreted as evidence of metabolic improvement rather than direct proof of enhanced insulin sensitivity.