Empagliflozin improved beta cell function and insulin sensitivity compared with insulin under conditions of equivalent glycemic control in type 2 diabetes mellitus (T2DM). Diabetologia published an open-label, randomized, cross-over study comparing empagliflozin with insulin therapy in individuals with non-insulin-treated T2DM.

Seventeen adults with T2DM underwent two 5-week treatment periods with empagliflozin or insulin titrated to achieve similar glycemic control, separated by a 3-week washout. Metabolic assessments were performed in the fasting state and during a 5-hour oral glucose tolerance test. Beta cell glucose sensitivity was derived from the relationship between insulin secretion and plasma glucose, while insulin sensitivity was assessed as glucose clearance relative to circulating insulin. The disposition index was calculated as the product of beta cell glucose sensitivity and insulin sensitivity.

Despite comparable glycemic control, insulin concentrations were higher during insulin treatment. Both beta cell glucose sensitivity and insulin sensitivity were higher during empagliflozin treatment, resulting in an improved disposition index compared with insulin therapy. These findings suggest that SGLT2 inhibition enhances beta cell function, potentially through reduced insulin-mediated inhibition rather than glycemic effects alone.