Type 2 diabetes is increasing in prevalence worldwide, and hyperglycemia is 
often poorly controlled despite a number of therapeutic options. Unlike 
previously available agents, sodium-glucose co-transporter 2 (SGLT2) inhibitors 
offer an insulin-independent mechanism for improving blood glucose levels, since 
they promote urinary glucose excretion (UGE) by inhibiting glucose reabsorption 
in the kidney. In addition to glucose control, SGLT2 inhibitors are associated 
with weight loss and blood pressure reductions, and do not increase the risk of 
hypoglycemia. Empagliflozin is a selective inhibitor of SGLT2, providing 
dose-dependent UGE increases in healthy volunteers, with up to 90 g of glucose 
excreted per day. It can be administered orally, and studies of people with 
renal or hepatic impairment indicated empagliflozin needed no dose adjustment 
based on pharmacokinetics. In Phase II trials in patients with type 2 diabetes, 
empagliflozin provided improvements in glycosylated hemoglobin (HbA1c) and other 
measures of glycemic control when given as monotherapy or add-on to metformin, 
as well as reductions in weight and systolic blood pressure. As add-on to basal 
insulin, empagliflozin not only improved HbA1c levels but also reduced insulin 
doses. Across studies, empagliflozin was generally well tolerated with a similar 
rate of hypoglycemia to placebo; however, patients had a slightly increased 
frequency of genital infections, but not urinary tract infections, versus 
placebo. Phase III studies have also reported a good safety profile along with 
significant improvements in HbA1c, weight and blood pressure, with no increased 
risk of hypoglycemia versus placebo. Based on available data, it appears that 
empagliflozin may be a useful option in a range of patients; however, clinical 
decisions will be better informed by the results of ongoing studies, in 
particular, a large cardiovascular outcome study (EMPA-REG OUTCOME™).