Empagliflozin’s role in cardiometabolic disease treatment: an Egyptian expert’s view

Abstract Background Given the expanding therapeutic indications of empagliflozin (EMPA) beyond glycemic control and the growing burden of cardiometabolic diseases, this review evaluated its efficacy, safety, and cost-effectiveness in the Egyptian population within the global context. Methods A comprehensive literature review of PubMed and Google Scholar identified clinical trials, systematic reviews, meta-analyses, and clinical guidelines published in English up to July 2025. We included studies reporting EMPA’s pharmacological profile, mechanisms of action, and clinical outcomes on diabetes mellitus, cardiometabolic diseases, renal and hepatic functions, safety during Ramadan fasting, and cost-effectiveness. Results EMPA, as monotherapy or combination therapy, improves glycemic control in type 2 diabetes through Sodium–glucose co-transporter-2 (SGLT-2) inhibition. For type 1 diabetes mellitus, despite improving glycemic control as an adjunct therapy, it is not recommended due to the increased risk of diabetic ketoacidosis. EMPA reduces major cardiovascular events, heart failure hospitalization, and chronic kidney disease progression, with modest weight loss and blood pressure reduction, in patients with or without diabetes. Emerging evidence suggests benefits in metabolic dysfunction-associated steatotic liver disease (MASLD), although it is not approved for this indication. EMPA demonstrates a favorable safety profile and low hypoglycemia risk during Ramadan fasting. It enhances patients’ quality of life and is considered cost-effective. Conclusions EMPA extends beyond glucose-lowering by reducing cardiorenal morbidity and mortality in patients with or without diabetes. It shows a favorable safety profile, even during Ramadan fasting, supporting its suitability for the large Muslim population. Further research should evaluate its role in MASLD and assess cost-effectiveness in Egypt.