Empagliflozin Benefits Span Older Subgroups

Empagliflozin reduced cardiovascular events consistently across sociodemographic subgroups.
*Propensity-matched cohort study; Level 2 (OCEBM).

Citation

Cromer SJ, Tesfaye H, Cho H, et al. Diabetes Care. 2026;49(12):1-10. doi:10.2337/dca26-0039

Background

Empagliflozin improves heart and kidney outcomes in type 2 diabetes, but trials may be too small to confirm whether benefits are similar across demographic and social groups. This study used Medicare data to examine real-world consistency of benefit.

Patients

Adults aged 65 years or older with type 2 diabetes in Medicare fee-for-service data, 2014-2020. Exclusions included type 1 diabetes, end-stage kidney disease, cancer, organ transplant, HIV/AIDS, nursing home admission, and inadequate prior enrollment.

Intervention

New initiation of empagliflozin.

Control

New initiation of dipeptidyl peptidase-4 inhibitors or glucagon-like peptide-1 receptor agonists.

Outcome

Modified major adverse cardiovascular events, heart failure hospitalization, and all-cause mortality.

Follow-up Period

Mean follow-up was about 10 months.

Results

Comparison Outcome Hazard ratio Absolute difference Approximate NNT/year
Empagliflozin vs dipeptidyl peptidase-4 inhibitors Major cardiovascular events HR 0.77 (99.9% CI 0.69 to 0.85) 10.3 fewer/1,000 person-years 97
Empagliflozin vs dipeptidyl peptidase-4 inhibitors Heart failure hospitalization HR 0.72 (99.9% CI 0.67 to 0.79) 18.3 fewer/1,000 person-years 55
Empagliflozin vs dipeptidyl peptidase-4 inhibitors Death HR 0.66 (99.9% CI 0.57 to 0.76) 8.6 fewer/1,000 person-years 116
Empagliflozin vs glucagon-like peptide-1 receptor agonists Heart failure hospitalization HR 0.88 (99.9% CI 0.81 to 0.95) 6.9 fewer/1,000 person-years 145

Benefits were similar by age, sex, race or ethnicity, insurance status, neighborhood deprivation, and baseline cardiovascular disease. Absolute benefits were larger in patients with existing cardiovascular disease. Major cardiovascular events and mortality were not significantly different versus glucagon-like peptide-1 receptor agonists.

Limitations

Observational claims data cannot prove causation, and unmeasured confounding may remain. Race and ethnicity were not self-reported. Results apply mainly to older Medicare fee-for-service patients. Some subgroups had limited event numbers.

Funding

Boehringer Ingelheim funded; employees coauthored, reportedly no design role.

Clinical Application

Consider empagliflozin for older adults with type 2 diabetes, especially with cardiovascular disease, when heart failure prevention is a priority.