From the Research
Jardiance (empagliflozin) should not be initiated in patients with a Hemoglobin A1c (HbA1c) level below 7%. This medication is indicated for adults with type 2 diabetes who have inadequate glycemic control despite diet and exercise, typically when HbA1c is 7% or higher. Starting Jardiance in patients with lower HbA1c levels may increase the risk of hypoglycemia without providing significant additional benefits.
Key Considerations
- Before initiating Jardiance, healthcare providers should assess renal function, as the medication is not recommended for patients with severe renal impairment (eGFR less than 30 mL/min/1.73m²) 1.
- Jardiance works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, which increases urinary glucose excretion and lowers blood glucose levels.
- This mechanism is most beneficial when there is significant hyperglycemia present, making the HbA1c threshold important for appropriate patient selection and optimal therapeutic outcomes.
Benefits and Risks
- The use of SGLT2 inhibitors like Jardiance has been associated with a reduced risk of major cardiovascular events, hospitalization for heart failure, and cardiovascular mortality 1.
- However, these medications can also increase the risk of diabetic ketoacidosis, particularly in patients with a history of pancreatitis or those taking other medications that increase the risk of ketoacidosis.
Patient Selection
- Patients with type 2 diabetes and established cardiovascular disease or at high risk of cardiovascular events may benefit from the use of SGLT2 inhibitors like Jardiance 1.
- The decision to initiate Jardiance should be based on individual patient factors, including renal function, cardiovascular risk, and the presence of other comorbidities.
Clinical Evidence
- A study published in the Lancet in 2021 highlighted the benefits of SGLT2 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes, including their ability to reduce the risk of major cardiovascular events and improve renal outcomes 1.
- The study also noted that these medications should be used with caution in patients with a history of pancreatitis or medullary thyroid cancer.