Insulin remains the only glucose-lowering treatment modality recommended in totally pancreatectomized (PX) patients. We investigated the effects of the sodium glucose transporter 2 (SGLT2) inhibitor empagliflozin on fasting and postprandial glucose concentrations in PX patients. In a randomized, double-blinded, placebo-controlled crossover study, 10 PX patients (age 65.7±6.4 [mean±SD] years; BMI 23.8±4.3 kg/m2) and 10 CTRLs (age 65±7.8 years; BMI 24.3±3.5 kg/m2) underwent a 3-hour liquid mixed meal test (MMT) preceded by two doses of 25 mg empagliflozin (administered the night before and on the morning of the MMT) and placebo, respectively. Basal insulin was administered as usual; no bolus insulin was administered during study days. Empagliflozin lowered fasting plasma glucose compared to placebo (5.0±0.5 vs. 7.9±0.9 mmol/l [mean±SEM], P=0.029) and postprandial plasma glucose excursions as assessed by baseline-subtracted area under curve (999±96 vs. 1,235±69 min×pmol/l, P=0.034) in the PX patients. In CTRLs, empagliflozin lowered fasting plasma glucose compared to placebo (5.2±0.1 vs. 5.5±0.1 mmol/l, P=0.021) without affecting postprandial glucose excursions significantly. Empagliflozin acutely and effectively decreases fasting plasma glucose and attenuates postprandial hyperglycemia in PX patients.
M. Baekdal: None. A. Lund: Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk A/S, Sanofi. S.W. Nielsen: None. J.H. Storkholm: None. C. Hansen: None. T. Vilsbøll: Advisory Panel; Self; AstraZeneca, Mundipharma International, Novo Nordisk A/S, Sun Pharmaceutical Industries Ltd. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medscape, Merck Sharp & Dohme Corp., Sanofi. F.K. Knop: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Sanofi. Consultant; Self; Carmot Therapeutics, Inc., Eli Lilly and Company, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Gubra, Novo Nordisk A/S, Sanofi, Zealand Pharma A/S. Speaker’s Bureau; Self; AstraZeneca, Lupin Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Norgine B.V., Novo Nordisk A/S.