Effect of Empagliflozin on Red Cell Indices in Type II Diabetes Mellitus Patients: A Comparative Study

Abstract

Background: Type 2 diabetes mellitus (T2DM) is associated with a significant burden of microvascular and hematological complications, with anemia frequently under-recognized despite its impact on patient outcomes. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as empagliflozin, may exert beneficial effects on erythropoiesis, but real-world data on red cell indices, particularly in South Asian populations, remain limited. Objective: To investigate the effect of empagliflozin on hemoglobin, hematocrit, and mean corpuscular volume in patients with T2DM. Methods: A comparative observational study was conducted at the Department of Endocrinology, Services Hospital, Lahore, from October 2024 to March 2025. Eighty-six adults with T2DM were allocated to either empagliflozin 10 mg daily (n=43) or standard oral hypoglycemic therapy (n=43) for six months. Red cell indices were measured at baseline and post-treatment. Data were analyzed using independent samples t-tests, with subgroup analyses by age and gender. Results: Empagliflozin treatment resulted in a significant increase in hemoglobin (mean change +1.49 g/dL, p=0.028) compared to controls (+0.36 g/dL), while post-treatment differences in hematocrit and mean corpuscular volume were not statistically significant. These findings were consistent across age and gender subgroups. Conclusion: Empagliflozin significantly improved hemoglobin levels in patients with T2DM, supporting its erythropoietic benefit. No meaningful effects were observed on hematocrit or mean corpuscular volume, underscoring the selective hematologic impact of this agent.