Comparison of Efficacy of Empagliflozin Versus Dapagliflozin in Type 2 Diabetes Among Inadequately Controlled on Metformin/Glemipride/DPP4 at a Tertiary Care Hospital
Abstract
Sodium–glucose cotransporter-2 (SGLT2) inhibitors improve glycemia, weight, and cardiometabolic risk in type 2 diabetes mellitus (T2DM). Head-to-head data comparing empagliflozin with dapagliflozin in South Asian routine care are limited. Objective: To compare the glycemic efficacy and safety of empagliflozin versus dapagliflozin as add-on therapy in adults with inadequately controlled T2DM receiving background oral agents. Methods: We conducted an open-label, randomized controlled trial at a tertiary public hospital (Department of Medicine, Nishtar Hospital, Multan, Pakistan) from 20 December 2024 to 20 May 2025. Adults aged 30–70 years with T2DM and baseline HbA1c 7.5%–12.0% were randomized 1:1 to empagliflozin 25 mg once daily or dapagliflozin 10 mg once daily, in addition to usual oral therapy (metformin, sulfonylurea, and/or DPP-4 inhibitor), for 24 weeks (N=256; 128 per arm). The primary endpoint was the proportion achieving HbA1c <6.5% at 24 weeks; secondary endpoints included mean change in HbA1c, the proportion achieving HbA1c <7.0%, fasting plasma glucose, body weight, blood pressure, and adverse events. Group comparisons used risk ratios with 95% confidence intervals for categorical outcomes and mean differences (95% CI) with two-sided p-values for continuous outcomes (α=0.05). Results: Baseline characteristics were balanced (mean age 52.6 ± 9.8 years; 54.7% male; mean HbA1c 8.80 ± 0.91%). At 24 weeks, mean HbA1c was 6.98 ± 0.68% with empagliflozin versus 7.28 ±…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 256 participants or records.
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