Objective  To systematically evaluate the efficacy and safety of empagliflozin (EMPA) combined with metformin (MET) in treating patients with type 2 diabetes mellitus.

  Methods  PubMed, the Cochrane Library, EMbase, Wanfang Data and CNKI were searched to collect the randomized controlled trials (RCTs) on empagliflozin plus metformin in treatment of patients with type 2 diabetes mellitus, and references of included studies were also retrieved. Two reviewers independently screened studies, extracted data, and assessed the methodological quality. All data were analyzed by Review Manager 5.3.

  Results  Five studies including 2 244 patients were included. The results of Meta-analysis showed that when compared to MET groups, EMPA plus MET showed better effect on the improvement of HbA1c levels weighted mean difference (WMD)=-0.47, 95% confidence interval (CI)=-0.72~-0.22, P < 0.05. There were no signi cant differences between EMPA plus MET groups and MET groups in the incidence of adverse events (RR=0.98, 95%CI=0.90~1.05, P=0.55), hypoglycemic incidence (RR=0.88, 95%CI=0.50~1.56, P=0.67) and incidence of urinary tract infections (RR=1.22, 95%CI=0.91~1.63, P=0.19). There was a signi cant difference between EMPA plus MET groups and MET groups in the incidence of genital infections (RR=4.12, 95%CI=2.31~7.34, P < 0.001).

  Conclusion  Based on this rexiew, EMPA plus MET has good efficacy and overall safety in treating patients with type 2 diabetes mellitus, but physicians should pay more attention to genital infections when they adopt this treatment method.