Summary: In a 20-week trial in type 2 diabetic peripheral neuropathy, adding empagliflozin 10 mg daily improved glycaemic control, renal indices, and nerve conduction velocity versus placebo, but did not change clinical examination scores or response amplitude.
PICO Summary
| Element | Detail |
|---|---|
| Population | 50 adults with type 2 diabetes and confirmed diabetic peripheral neuropathy (Michigan Neuropathy Screening Instrument). |
| Intervention | Empagliflozin 10 mg once daily added to existing regimen for 20 weeks. |
| Comparison | Placebo added to the existing regimen over the same 20 weeks. |
| Outcome | Significant falls in HbA1c and fasting glucose, lower creatinine and higher eGFR, increased nerve conduction velocity and reduced latency, improved MNSI oral score. No significant change in response amplitude or clinical examination score. No major adverse events. |
Empagliflozin and nerve conduction in T2D neuropathy
RCT · type 2 diabetes · 20 weeks
Empagliflozin raised nerve conduction velocity and lowered HbA1c versus placebo, but examination scores and amplitude did not change; glycaemic improvement confounds the nerve signal.
Expert Commentary
The idea that an agent I already prescribe for cardiorenal protection might also help the nerves is appealing, and the mechanistic story, microvascular and oxidative-stress benefit on top of glucose lowering, is plausible. But I read the results with discipline, because the trial is honest about what did not move. Nerve conduction velocity rose and latency fell, yet response amplitude and the clinical examination score did not change, which tempers any talk of genuine axonal recovery over a mere twenty weeks in a slowly evolving complication. The bigger interpretive problem is confounding: glycaemia, renal indices, and conduction all improved together, so better glucose control alone could account for much of the neurological signal, and the drug’s independent nerve effect is hard to isolate. The report also gives directions of effect without effect sizes or confidence intervals. Can I use this with my patients? Yes, but only as I already do: empagliflozin is a sound choice for its established cardiorenal benefits, and any nerve-conduction improvement is a welcome bonus, not a reason to start it as a neuropathy treatment. Foot care and glycaemic optimisation remain the foundation. I would want a longer, neuropathy-focused trial with clinical endpoints.
References
Vafaeinasab M, Mirzaei Malekabad F, Khatibi A, et al. The comparison of the effect of adding empagliflozin to the medication regimen on peripheral neuropathy in patients with type II diabetes: a double blind randomised clinical trial. Endocrinol Diabetes Metab. 2025;8(6):e70128. doi:10.1002/edm2.70128