BackgroundThe sodium-glucose co-transporter 2 inhibitor empagliflozin improves cardiovascular outcome in patients with type 2 diabetes mellitus (T2DM) and heart failure. Experimental studies suggest a direct cardiac effect of empagliflozin associated with an improvement in left ventricular diastolic function.MethodsIn the randomized, double-blind, two-armed, placebo-controlled, parallel group trial EmDia, patients with T2DM and elevated left ventricularE/E´ ratio were enrolled and randomized 1:1 to receive empagliflozin 10 mg/day versus placebo. The primary endpoint was the change of left ventricularE/E´ ratio after 12 weeks of intervention.ResultsA total of 144 patients with T2DM and an elevated left ventricularE/e´ ratio (age 68.9 ± 7.7 years; 14.1% women;E/e´ ratio 9.61[8.24/11.14], left ventricular ejection fraction 58.9% ± 5.6%). After 12 weeks of intervention, empagliflozin resulted in a significant higher decrease in the primary endpointE/e´ ratio by − 1.18 ([95% confidence interval (CI) − 1.72/− 0.65];P< 0.0001) compared with placebo. The beneficial effect of empagliflozin was consistent across all subgroups and also occurred in subjects with heart failure and preserved ejection fraction (n= 30). Additional effects of empagliflozin on body weight, HbA1c, uric acid, red blood cell count, hemoglobin, mean corpuscular hemoglobin, and hematocrit were detected (allP< 0.001). Approximately one-third of the reduction inE/e´ by empagliflozin could be explained by the variables examined.ConclusionsEmpagliflozin improves diastolic function in patients with T2DM and elevated end-diastolic pressure. Since the positive effects were consistent in patients with and without heart failure with preserved ejection fraction, the data add a mechanistic insight for the beneficial cardiovascular effect of empagliflozin.Trial registrationClinicaltrials.gov, unique identifier: NCT02932436.Graphical abstractSupplementary InformationThe online version contains supplementary material available at 10.1007/s00392-023-02164-w.