Recent studies have shown that drugs that inhibit the sodium-glucose co-transporter 2 (SGLT2i) can prevent heart failure and kidney disease when used to treat diabetes. Although the molecular mechanism of these drugs is well-known, it is very unclear how the inhibition of this transporter resulted in such profound effects on heart disease, kidney disease and mortality.
One possible explanation is the impact that they may have indirectly on the autonomic nervous system. We will be initiating a study (funded by Boehringer Ingelheim) in late 2017, which will undertake very detailed measurements of cardiac autonomic function among people with diabetes randomised to be treated with either the SGLT2i, empagliflozin, or placebo. The findings from this study will provide important information on how these drugs work, and how new interventions can be developed to reduce morbidity and mortality in people with diabetes.