The EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus) trial found that adding empagliflozin, a sodium-glucose co-transporter-2 inhibitor (SGLT-2i), to a standard of care, reduces the relative risk of cardiovascular death by 38%, all-cause mortality by 32%, and hospitalization for heart failure (HHF) by 35% when compared to placebo in patients with type 2 diabetes. (T2D). More than 99 percent of EMPAREG OUTCOME participants had a history of cardiovascular disease. AIM The primary objective of the study is to evaluate the safety and efficacy of empagliflozin in patients with Metabolic syndrome. CONCLUSION It is too early to compare the perks of empagliflozin to those of other glucose-lowering drugs in routine clinical settings, particularly for patients without a history of cardiovascular disease. In addition, although safety data for empagliflozin and other SGLT-2i have been reported in substantial RCTs, evidence regarding the safety of these drugs is still accumulating because RCTs are typically underpowered to detect rare outcomes that may become apparent in larger and more broadly defined populations. Empagliflozin's safety has not been evaluated in a substantial real-world population for potential severe unintended adverse effects of SGLT-2i, including bone fractures, lower limb amputations (LLA), diabetic ketoacidosis (DKA), and acute kidney injury (AKI).