Effectiveness of Empagliflozin With Vitamin D Supplementation in Peripheral Neuropathy in Type 2 Diabetic Patients

Abstract

Background: Neuropathy is the most prevalent broad-spectrum microvascular complication of diabetes. The present study aims to evaluate the effect of empagliflozin with vitamin D supplementation on diabetic peripheral neuropathy.Methods: A prospective, randomized, controlled study was conducted for six months including 150 type 2 diabetic patients, divided into three groups (n=50/group): Group 1, patients on oral hypoglycemic agents; Group 2, patients on empagliflozin and Group 3, patients on empagliflozin with vitamin D. Biochemical parameters were estimated for outcome measurements and patients' neuropathic pain was analysed using Douleur Neuropathique 4 Questions, Neuropathic Pain Symptom Inventory and Ipswich Touch the toes test questionnaire. Data were analysed using a one-way analysis of variance.Results: Diabetic neuropathy in males was more prevalent (more than 50%) as compared to females in all three groups, with an average age of 50±6 years, along with a diabetic history of 15±4.5 years and a glycated hemoglobin A1C (HbA1C) level of >10%. The mean value of serum vitamin D level significantly increased by 64.7% (19±5 to 54±8 ng/mL; p<0.05). A remarkable decrease (by 17.4%) from baseline in the HbA1C level was observed after six months of treatment only in Group 3, whereas in other groups (1 and 2), there was a nonsignificant decrease in HbA1C levels when compared to baseline. Moreover, a significant improvement in neuropathic condition was seen only in Group 3. Conclusion:The results indicated that empagliflozin with vitamin D supplementation significantly controlled or reduced HbA1C and improved diabetic neuropathic symptoms in patients. It is suggested that this combination can be considered as the primary therapeutic approach for neuropathic complications in diabetic patients.

The effect of empagliflozin on monocyte high-density lipoprotein ratio in patients with type 2 diabetes mellitus

“…In the study of the effect of empagliflozin on diabetic microvascular complications, Eid et al (32) did not find any effect on neuropathy in T2DM subjects. In the study of Mehta et al (33) patients using empagliflozin did not detect any difference in the improvement of diabetic neuropathy when compared to patients using other oral antihyperglycemic drugs. In our study, we did not find any changes in the biochemical and hemogram parameters of diabetic neuropathy patients using empagliflozin in accordance with the literature.…”

The Outcomes of Sodium-Glucose Co-transporter 2 Inhibitors (SGLT2I) on Diabetes-Associated Neuropathy: A Systematic Review and meta-Analysis

“…Based on the Cochrane Collaboration’s tool for assessing the risk of bias, all four included RCTs ( Jordan et al, 2017 ; Shimizu et al, 2020 ; Mehta et al, 2021 ; Liao et al, 2022 ) showed a low risk of selection bias, performance bias, and reporting bias. Three studies ( Jordan et al, 2017 ; Mehta et al, 2021 ; Liao et al, 2022 ) showed an unclear risk of selection bias, while two ( Jordan et al, 2017 ; Mehta et al, 2021 ) showed a high risk of detection bias. Three of the four studies ( Shimizu et al, 2020 ; Mehta et al, 2021 ; Liao et al, 2022 ) showed a low risk of attribution bias, and one study ( Jordan et al, 2017 ) showed a high risk.…”

“…Three studies (Jordan et al, 2017;Mehta et al, 2021;Liao et al, 2022) showed an unclear risk of selection bias, while two (Jordan et al, 2017;Mehta et al, 2021) showed a high risk of detection bias. Three of the four studies (Shimizu et al, 2020;Mehta et al, 2021;Liao et al, 2022) showed a low risk of attribution bias, and one study (Jordan et al, 2017) showed a high risk. The NIH quality assessment tool revealed that two studies (Wang et al, 2019;Sardu et al, 2022) were good quality (Figure 2 and Table 1).…”

Role of vitamin d in patients with type 2 diabetes mellitus

“…En cuanto a la información sobre el rol de la vitamina D en pacientes con diabetes mellitus tipo 2 (Tabla 1), la mayoría de artículos se relacionaba con la diabetes mellitus tipo 2, pero también hacía más relación a los otros diferentes tipos de diabetes como la diabetes tipo 1 o sus complicaciones como neuropatía diabética, pie diabético o relacionadas al sistema cardiovascular. (11,13,14,16,17,19,23,24,25,26,27) Las características fundamentales del diseño y resultados de los estudios sobre el rol de la vitamina D en pacientes diabéticos tipo II se muestra en la Tabla 2.…”