From the Guidelines
Empagliflozin is the most effective SGLT2 inhibitor for reducing morbidity, mortality, and improving quality of life in patients with type 2 diabetes, particularly those with established cardiovascular disease, as evidenced by the EMPA-REG OUTCOME trial 1.
Key Points
- SGLT2 inhibitors, such as empagliflozin, dapagliflozin, and canagliflozin, are a class of medications that lower blood sugar levels by increasing glucose excretion in the urine.
- These medications have been shown to have cardiovascular and renal benefits, including reducing the risk of hospitalization for heart failure and slowing kidney disease progression 1.
- Empagliflozin, in particular, has been demonstrated to reduce major adverse cardiovascular events (MACEs) by 14% and cardiovascular mortality by 38% in patients with established cardiovascular disease 1.
- The benefits of SGLT2 inhibitors are not limited to patients with diabetes, as they have also been shown to be effective in reducing the risk of hospitalization for heart failure and slowing kidney disease progression in patients without diabetes.
- Common side effects of SGLT2 inhibitors include genital yeast infections, urinary tract infections, and a small risk of diabetic ketoacidosis.
- Patients with kidney impairment should use SGLT2 inhibitors with caution, and adequate hydration is essential while taking these medications 1.
Recommendations
- Empagliflozin should be considered as a first-line treatment for patients with type 2 diabetes and established cardiovascular disease, due to its proven benefits in reducing MACEs and cardiovascular mortality 1.
- Patients with kidney impairment should be closely monitored while taking SGLT2 inhibitors, and the dose should be adjusted accordingly to minimize the risk of adverse effects 1.
- Healthcare providers should educate patients on the importance of maintaining adequate hydration while taking SGLT2 inhibitors to reduce the risk of dehydration and acute kidney injury 1.
From the FDA Drug Label
Sodium-glucose co-transporter 2 (SGLT2) is the predominant transporter responsible for reabsorption of glucose from the glomerular filtrate back into the circulation. Empagliflozin is an inhibitor of SGLT2
- Medication: Empagliflozin
- Class: SGLT2 inhibitor 2
From the Research
SGLT2 Inhibitors
- SGLT2 inhibitors are a class of oral antihyperglycemic medication used in the treatment of type 2 diabetes, with examples including empagliflozin, canagliflozin, and dapagliflozin 3, 4, 5, 6, 7
- These medications work by reducing hyperglycemia through increasing urinary glucose excretion and have favorable effects beyond glucose control, including consistent body weight, blood pressure, and serum uric acid reductions 3, 6, 7
Medications
- Empagliflozin (Jardiance®) is a potent, highly selective SGLT2 inhibitor, effective and generally well tolerated for the treatment of adults with type 2 diabetes 3, 7
- Canagliflozin (Invokana) and dapagliflozin (Farxiga) are also SGLT2 inhibitors used for the treatment of type 2 diabetes, with comparable cardiovascular effectiveness to empagliflozin at clinically effective doses 4, 5
- These medications have a low inherent risk of hypoglycaemia due to their insulin-independent mechanism of action, enabling them to be used as monotherapy and as a component of combination therapy with other antidiabetic agents 3, 6
Benefits and Side Effects
- SGLT2 inhibitors offer several benefits, including improvements in glycaemic control, weight loss, and lowering of blood pressure, as well as cardioprotective and renoprotective properties 3, 4, 6, 7
- Common side effects of SGLT2 inhibitors include genital mycotic infections, urinary tract infections, and events linked to volume depletion, although these are generally rare 3, 6, 7
- Empagliflozin has been shown to have a low risk of hypoglycemia and no increased risk of amputation or bone fractures, making it a valuable treatment option for patients with type 2 diabetes 3, 7