From the Guidelines
Empagliflozin (Jardiance) is a highly effective medication for managing type 2 diabetes, offering significant cardiovascular benefits, including reducing the risk of heart failure hospitalizations and cardiovascular death, as well as providing renal protection. The medication works by blocking glucose reabsorption in the kidneys, causing excess glucose to be eliminated through urine rather than remaining in the bloodstream. It is typically prescribed at a starting dose of 10 mg once daily, which can be increased to 25 mg daily if needed, as supported by the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1. Beyond lowering blood glucose levels, Empagliflozin has been shown to reduce the composite outcome of MI, stroke, and cardiovascular death by 14% and cardiovascular death by 38% in patients with established cardiovascular disease, as demonstrated in the EMPA-REG OUTCOME trial 1. Common side effects include genital yeast infections and increased urination, and patients should maintain adequate hydration while taking this medication and temporarily stop it during periods of acute illness to prevent dehydration. Empagliflozin should be used cautiously in patients with renal impairment and is not recommended when eGFR falls below 30 ml/min/1.73m², as indicated in the standards of medical care in diabetes-2022 1. Key benefits of Empagliflozin include:
- Cardiovascular risk reduction
- Renal protection
- Modest weight loss and blood pressure reduction
- Reduced risk of heart failure hospitalizations It is essential to consider the potential risks and benefits of Empagliflozin in individual patients, taking into account their specific clinical characteristics and comorbidities, as outlined in the standards of care in diabetes-2023 1 and the chronic kidney disease and risk management guidelines 1.
From the FDA Drug Label
JARDIANCE is 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 role of Empagliflozin (Jardiance) in managing type 2 diabetes mellitus is:
- 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 2, 2, 2
From the Research
Role of Empagliflozin in Managing Type 2 Diabetes Mellitus
Empagliflozin, also known as Jardiance, plays a significant role in managing type 2 diabetes mellitus (T2DM) due to its unique mechanism of action as a sodium-glucose cotransporter 2 (SGLT2) inhibitor. This class of drugs works by promoting the excretion of glucose in the urine, thereby lowering plasma glucose levels independently of β-cell function 3.
Clinical Benefits
The clinical benefits of empagliflozin include:
- Reduction in cardiovascular morbidity and mortality in patients with T2DM and established cardiovascular disease, as demonstrated in the EMPA-REG OUTCOME trial 4, 3, 5, 6.
- Improvement in glycemic control, with significant reductions in glycated hemoglobin (HbA1c) levels 3, 7.
- Modest reductions in body weight and blood pressure, contributing to an overall favorable effect on non-glycemic outcomes 3, 5.
- Reduced risk of hospitalization for heart failure and renal adverse events 6.
Safety and Tolerability
Empagliflozin is generally well-tolerated, with a low inherent risk of hypoglycemia due to its insulin-independent mechanism of action 3, 5. However, it is associated with a higher rate of genital mycotic infections compared to placebo 3, 6. The adverse event profile of empagliflozin is consistent across different patient populations, including those with chronic kidney disease 4.
Dosage and Administration
The efficacy and safety of empagliflozin at different doses have been evaluated in several studies. A network meta-analysis suggested that a daily dose of 25 mg performs best among different doses in terms of lowering HbA1c and fasting plasma glucose levels, while also considering safety 7.
Patient Selection
Empagliflozin is a valuable treatment option for patients with T2DM, particularly those at high cardiovascular risk who require additional antidiabetic medication to achieve their glycemic goals 5, 6. However, careful consideration of individual patient characteristics, such as renal function and history of genital mycotic infections, is necessary to ensure appropriate use.