One of the main goals in managing type 2 diabetes in adults is prevention of cardiovascular morbidity and mortality (1,2). Only a few of the available diabetes medications have shown benefits in reducing cardiovascular risks; most available drug classes such as thiazolidinediones, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter 2 (SGLT2) inhibitors have been approved based on their ability to decrease glycosylated hemoglobin A1c (HbA1c) rather than their ability to prevent morbidity and mortality (3,4). Network meta-analyses of SGLT2 inhibitors suggest lower risk of all-cause and cardiovascular mortality from 3 oral SGLT2 inhibitors combined, at the expense of higher risk of nonfatal stroke [pooled relative risk (RR) 1.30; 95% confidence interval (CI): 1–1.68], genital infection (pooled RR 4.75; 95% CI: 4.00–5.63), and volume depletion (pooled RR 1.53; 95% CI: 1.27–1.83) (5,6). However, the reduction in the risk of mortality and morbidity is mostly attributable to one drug, empagliflozin, the only drug approved by the FDA in 2016 to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease (5,6).
