Abstract 4371800: 37,500 man-years of clinical expertise validate the cardio-metabolic benefits of empagliflozin-linagliptin in type 2 diabetes: findings from the amplified consensus

Abstract

Background and Aims: Perception mapping studies are crucial to understanding real-world applicability of SGLT2 and DPP4 inhibitor combinations in India’s clinical setting. The AMPLIFIED (Accelerating Multi-Pathway Integration for Linagliptin and Empagliflozin in Diabetes) consensus explored evolving paradigms in T2DM treatment. Materials and Methods: Conducted over 39 virtual sessions, the study engaged 1,500 physicians representing over 37,500 cumulative clinical years. Participants evaluated 11 key statements on empagliflozin-linagliptin combination therapy using a 5-point Likert scale. Analysis using GraphPad 10.4.0 defined expert agreement at weighted scores (WS) >100. Results: Experts rated the combination as more effective than monotherapy for glycemic control (WS: 107.1), with sustained 52-week efficacy (WS: 104.4). Strong backing from long-term trials by Kaku, Kawamori, and DeFronzo confirmed its effectiveness (WS: 110.0). Linagliptin was favored over sitagliptin, especially for renal impairment and diabetes complications (WS: 103.1). Cardiovascular benefits of empagliflozin, as shown in EMPA-REG OUTCOME, were highlighted—reducing CV risk (WS: 103.4), mortality, and HF hospitalizations (WS: 112.4). Further support came from the 2020 ACC expert consensus (endorsed by ADA) advocating SGLT2 inhibitors for CV and renal protection (WS: 118.8). These align with India's rising burden of CV-related deaths (WS: 119.9). Empagliflozin was noted to narrow the healthspan-lifespan gap by reducing HFH and improving metabolic parameters (WS: 114.9). Compared to other SGLT2 inhibitors, it demonstrated superior CV outcomes and lower HFH risk (WS: 101.0). It also reduced epicardial adipose tissue thickness in T2DM and obese individuals (WS: 114.6). Overall mean response scores: Agree – 63±8.7 (95% CI: 57–69), Strongly Agree – 46±14 (95% CI: 37–55), p<0.0001. Conclusion: The AMPLIFIED consensus identifies the empagliflozin-linagliptin combination as a game-changing option in T2DM care. With strong evidence of durable glycemic control, cardiorenal protection, and improved life expectancy, this dual therapy offers a holistic and effective strategy, particularly in high-risk diabetic populations.