Strengths and weaknesses
diabetes
INSULIN RESISTANCE, INSULIN SENSITIVITY, DIABETES
Major strengths of this study include its double-blind, randomized design and investigations at three different time points, including after treatment withdrawal, which further confirms that the observed effects are attributable to empagliflozin. Several validated indexes were described, permitting a detailed assessment of the effects of empagliflozin on different processes involved in glucose homeostasis, as well as on other variables associated with insulin resistance, e.g., mannose levels and lipid indexes. Another strength is the use of CMR to examine myocardial performance and structure.This study also has some limitations. The sample size was relatively limited, and OGTT-derived surrogates were used for measuring insulin resistance/sensitivity and β-cell function. An OGTT is widely used to diagnose diabetes and represents the only accepted method to detect IGT [Finally, it cannot be excluded that the modest but significantly different decrease in BMI in the empagliflozin-treated group (–0.5 ± 0.8) compared to that observed in the placebo group (–0.3 ± 0.8) may have, at least in part, contributed to the improvement in insulin sensitivity.