# Expert Opinion of Empagliflozin Positioning in the Current Type 2 Diabetes Mellitus (T2DM) Landscape in Indian Patients

## TL;DR

Experts in India widely support empagliflozin as a key treatment for type 2 diabetes, especially for patients with heart, kidney, or metabolic issues.

## Contribution

The paper presents expert consensus on empagliflozin's role in T2DM management in India, emphasizing its early use and broad benefits.

## Key findings

- 95% of experts agree empagliflozin should be foundational for T2DM patients with cardiovascular disease.
- 93% support its use for heart failure prevention and slowing kidney disease progression.
- 83% perceive empagliflozin to have a superior clinical profile compared to other SGLT2 inhibitors.

## Abstract

Background

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder associated with significant macrovascular and microvascular complications. Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has demonstrated benefits beyond glycemic control, including cardiovascular and renal protection. As a result, it is increasingly prescribed for patients with T2DM who are at an elevated risk of adverse cardiorenal outcomes, specifically those with established atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or chronic kidney disease (CKD).

Objective

This study aimed to evaluate clinicians' perspectives on the role of empagliflozin in the management of T2DM in India, particularly among patients with cardiovascular, renal, and metabolic comorbidities.

Methods

A structured new age for a virtual advisory board was conducted with overall 625 experts, including endocrinologists, diabetologists, and cardiologists from diverse regions of India. The 16-item questionnaire used in this advisory board was developed by an expert panel based on published evidence and clinical experience; however, it was not formally validated or pilot-tested prior to administration. As such, responses may reflect expert opinion and clinical judgment rather than performance on a standardized, validated instrument.

Results

Strong consensus was observed across key domains: 95% agreed that empagliflozin should be a foundational therapy for T2DM patients with ASCVD, while 93% supported its use for HF prevention across all ejection fractions, and 93% endorsed its role in slowing the progression of diabetic kidney disease. Early initiation in high cardiorenal risk patients, even before metformin, was favored by 90%. Additionally, 92% supported its use in non-diabetic HF and CKD patients. Notably, 83% of clinicians perceived empagliflozin to have a superior clinical profile compared with other SGLT2 inhibitors; however, this reflects expert perception rather than direct comparative evidence, and many benefits are recognized as class effects across the SGLT2 inhibitor group. A favorable safety profile was affirmed by 86% of experts, while additional benefits such as metabolic dysfunction-associated steatotic liver disease (MASLD) improvement (86%), quality-of-life enhancement (90%), and uric acid reduction (84%) were also acknowledged based on clinical experience and emerging evidence.

Conclusion

This expert consensus highlights widespread clinical support for empagliflozin as a cornerstone therapy in T2DM, especially for patients with cardiovascular, renal, or metabolic risk. Its multidimensional benefits support early initiation and broad application in Indian clinical practice.