In Reply We agree with Dr Venker that HbA1c levels were not the same in the placebo and active treatment groups of the EMPA-REG OUTCOME and LEADER trials and appreciate his careful analysis of HbA1c levels over time. However, we still characterize these differences in HbA1c levels as “small.”
In our Viewpoint, we stated that the effects of treatment with empagliflozin and liraglutide on cardiovascular outcomes were “out of proportion” to these small differences in glycemic control levels. This statement is supported by the following evidence.
Lipska KJ, Krumholz HM. Hemoglobin A1c as a Surrogate for Clinical Outcomes in Diabetes Studies—Reply. JAMA. 2017;318(2):200-201. doi:10.1001/jama.2017.7225