What is the role of Jardiance (empagliflozin) in managing type 2 diabetes and cardiovascular risk?

From the Guidelines

Jardiance (empagliflozin) is a highly effective medication for managing type 2 diabetes while also providing significant cardiovascular protection, particularly in reducing the risk of hospitalization for heart failure by about 35% and cardiovascular death by approximately 38%. It belongs to the SGLT2 inhibitor class and works by preventing glucose reabsorption in the kidneys, allowing excess glucose to be excreted through urine. The standard dosage is 10mg once daily, which can be increased to 25mg daily if needed for better glycemic control. Jardiance not only lowers blood glucose levels but has demonstrated remarkable benefits in reducing major adverse cardiovascular events, particularly in patients with established cardiovascular disease.

Some of the key benefits of Jardiance include:

• Modest weight loss (typically 2-3kg)
• Blood pressure reduction
• Kidney protection
• Reduced risk of cardiovascular death and hospitalization for heart failure

Common side effects include:

• Genital yeast infections
• Increased urination
• Slight initial decrease in kidney function that typically stabilizes

According to the most recent and highest quality study, the use of Jardiance is recommended to reduce the risk of worsening heart failure and cardiovascular death in people with type 2 diabetes and established HFpEF or HFrEF 1. Patients should maintain adequate hydration while taking this medication and be aware of the potential risks, including severe genitourinary infections and, less commonly, diabetic ketoacidosis 1. Jardiance should be taken in the morning with or without food, and patients should continue their other diabetes medications unless advised otherwise by their healthcare provider.

The selection of Jardiance may depend on comorbidity and CKD stage, and it may be more useful for patients at high risk of CKD progression (i.e., with albuminuria or a history of documented eGFR loss) 1. Overall, Jardiance is a valuable treatment option for managing type 2 diabetes and reducing cardiovascular risk, and its benefits have been consistently demonstrated across multiple studies 1.

From the FDA Drug Label

JARDIANCE is a sodium-glucose co-transporter 2 (SGLT2) inhibitor indicated: as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus, to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease. The benefits of Jardiance (empagliflozin) are:

• Improving glycemic control in adults with type 2 diabetes mellitus
• Reducing the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease 2

From the Research

Benefits of Jardiance (Empagliflozin) in Managing Type 2 Diabetes and Cardiovascular Risk

• Empagliflozin is an effective and generally well-tolerated antihyperglycaemic agent for the treatment of adults with type 2 diabetes (T2D) 3.
• It offers a low inherent risk of hypoglycaemia due to its insulin-independent mechanism of action, enabling it to be used as monotherapy and as a component of combination therapy with other antidiabetic agents 3.
• Empagliflozin exerts a favourable effect on several nonglycaemic outcomes, including:
  • Modest reductions in body weight 3, 4
  • Blood pressure reductions (systolic approximately 4 mm Hg and diastolic approximately 2 mm Hg) 4
• As an adjunct to standard care, empagliflozin demonstrated cardioprotective and renoprotective properties largely independent of glycaemic control in patients with T2D and established cardiovascular disease (CVD) in a mandated cardiovascular (CV) outcomes trial (EMPA-REG OUTCOME) 3, 5.
• Empagliflozin may reduce mortality in patients with T2D and significant cardiovascular risk factors, with this benefit not seeming to be related to the hypoglycaemic effect of empagliflozin or to prevention of the cardiovascular complications of diabetes, but rather to prevention of heart failure in patients with a history of cardiovascular disease 5.

Comparison with Other SGLT2 Inhibitors

• Empagliflozin has been compared to other SGLT2 inhibitors, such as canagliflozin and dapagliflozin, in terms of cardiovascular effectiveness and safety 6, 7.
• The comparative effectiveness study found that individual SGLT-2 inhibitors demonstrated comparable cardiovascular effectiveness at clinically effective doses, though low-dose dapagliflozin showed a reduced benefit for heart failure hospitalization compared with empagliflozin 6.
• The neurohumoral responses to the 3 SGLT2i (empagliflozin, canagliflozin, and dapagliflozin) are different under similar volume correction in HF patients with T2DM 7.

Safety and Adverse Effects

• Empagliflozin shares the adverse effects of other gliflozins, including genital infections, kidney failure, and diabetic ketoacidosis 5, 4.
• The risk of hypotension and volume depletion is low, although it should be carefully checked in more fragile and at-risk patients 4.
• Empagliflozin may also be hepatotoxic, and a risk of cancer (especially bladder cancer) cannot be ruled out 5.