1208-P: Empagliflozin and HbA1c Reduction in a National Cohort

Empagliflozin, a sodium-glucose cotransport 2 inhibitor, provides A1c reduction by .6-1.0% in large randomized control trials. These trials included adults with type 2 diabetes (T2D) who had baseline A1c 7-10%. The use of empagliflozin in reducing A1c in clinical practice has not been investigated. We constructed a longitudinal cohort of 16391 adults with T2D who initiated empagliflozin from 11/1/2014 to 3/1/2018 in the Veterans Health Administration and followed them until 10/1/2018. We studied 7792 adults (96% men, 73% non-Hispanic white (NHW), 14% black) who had A1c measures at baseline and during follow-up and who did not change their antidiabetic medication regimens (58% with insulin, 36% without insulin). Linear regression estimated absolute A1c change at 6 months, adjusted for age, sex, race/ethnicity, baseline A1c, categorical BMI, kidney function, and concurrent insulin. At baseline, median A1c was 8.5% (12% with A1c ≥10%), median BMI was 33 kg/m² (25% of adults with BMI 35-40 kg/m², 18% BMI >40 kg/m²), and 19% with reduced kidney function. Baseline A1c was 8.9% for black adults and 8.5% for NHW adults. The average reduction in A1c was .74% for black adults and .70% for NHW adults. Overall, average adjusted A1c reduction was .71%. Adults with baseline A1c ≥10% had a greater adjusted reduction compared to adults with baseline A1c 7-10% (1.76% vs. .46%, p<.001). Adults with BMI 35-40 kg/m² and >40 kg/m² had a greater adjusted reduction compared to normal and overweight adults (.71% and .75%, vs. .46% and .59%, respectively, p <.001). Adults on a concurrent insulin regimen had a smaller adjusted reduction compared to those with a non-insulin regimen (.50% vs. .72%, p<.001). Empagliflozin decreased A1c in T2D adults across a range of ages, races/ethnicities, BMIs and concurrent insulin prescription. Empagliflozin seems to offer the greatest A1c reduction for T2D adults with A1c ≥10% or BMI >35. This study provides real-world evidence of empagliflozin use and A1c reduction in a large integrated healthcare system.