Comparison of Metformin combined with Empagliflozin or Sitagliptin on Glycemic Status, Renal Function, and Albumiuria in Patients with Type 2 Diabetes Mettitus

Abstract

Background: Type 2 diabetes mellitus is frequently complicated by insulin resistance and early renal impairment, including albuminuria. Metformin is still  the  first-line  treatment,  but  other  drugs  like  sodium–glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors are often needed as well. There is still not enough comparative evidence about how they affect the kidneys and metabolism in everyday clinical practice.
Aims: The objective of this study was to evaluate the effects of metformin in conjunction with empagliflozin or sitagliptin on glycemic control, insulin resistance,  renal  function,  and  albuminuria  in  individuals  with  type  2 diabetes mellitus.
Patients and Methods: In this cross-sectional comparative study, 133 individuals with type 2 diabetes mellitus were chosen and divided into two groups  based  on  their  current  treatment:  metformin  combined  with empagliflozin (n = 67) or metformin combined with sitagliptin (n = 66). We looked at glycemic indices, insulin levels, insulin resistance, beta cell function, renal function parameters, estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio.
Results: Patients taking metformin and empagliflozin had much lower fasting  serum glucose  (p=0.005), insulin levels  (p=0.002), and  insulin resistance  (p=0.001) than those  taking metformin and sitagliptin. This shows  that  their insulin  sensitivity  improved. The studied  groups  had similar levels  of HbA1c,  beta  cell function, and estimated  glomerular filtration rate. The urinary albumin-to-creatinine ratio was significantly lower  in the  empagliflozin  group (p  =  0.03). In both  groups, urinary albumin-to-creatinine ratio had a positive correlation with insulin resistance and a negative correlation with estimated glomerular filtration rate.
Conclusion:  Both  combinations  had  similar  effects  on  HbA1c,  but metformin plus empagliflozin worked better at lowering insulin resistance and albuminuria. This suggests that metformin plus empagliflozin has an improved early renoprotective profile for people with T2DM.