Treating the Metabolic Syndrome With a Sodium-glucose Cotransporter-2 Inhibitor

Inclusion criteria

• Male or female aged over 18 years and younger than 85 years
• Fulfils the criteria for the metabolic syndrome [1] (waist ≥90cm in men or ≥80cm in women plus at least two other components: triglycerides ≥1.7 mmol/L; HDL <1.03 in men and <1.29 in women; blood pressure ≥130 mmHg systolic or ≥85 mmHg diastolic or previously diagnosed hypertension; fasting plasma glucose ≥5.6 mmol/L)
• Willing to take part in the study and give informed consent

Exclusion criteria

• Taking medications for diabetes, including oral agents, insulin or glucagon-like peptide-1 agonists
• Fasting plasma glucose ≥7.0 mmol/L or HbA1c ≥6.5% before randomisation
• Diagnosis of type 1 diabetes
• Taking medications for hypertension, unless the blood pressure is well controlled with a stable regime
• Patient who cannot be randomised to placebo because of a strong indication for an SGLT2 inhibitor
• Contraindications to empagliflozin (GFR <60 ml/min/1.73m2)
• History of intolerance or adverse reactions to an SGLT2 medication
• Co-morbidities that make the subject unsuitable to be a study subject
• Mental illness that makes the subject unsuitable
• Cognitive dysfunction
• Pregnancy
• Thyroid disease