From the Guidelines
Empagliflozin (Jardiance) is a highly effective medication for managing type 2 diabetes mellitus, offering significant cardiovascular and renal benefits, and should be considered as a first-line treatment for patients with established cardiovascular disease or at high risk of cardiovascular events, as evidenced by the EMPA-REG OUTCOME trial 1.
Mechanism of Action and Dosage
Empagliflozin belongs to the sodium-glucose cotransporter-2 (SGLT2) inhibitor class, which works by increasing glucose excretion through the kidneys. It is typically prescribed at a starting dose of 10 mg once daily, which can be increased to 25 mg daily if needed for better glycemic control.
Cardiovascular Benefits
Beyond lowering blood glucose levels, Empagliflozin offers significant cardiovascular benefits, including reduced risk of heart failure hospitalizations and cardiovascular death, particularly in patients with established cardiovascular disease. The EMPA-REG OUTCOME trial demonstrated that Empagliflozin reduced the composite outcome of MI, stroke, and cardiovascular death by 14% and cardiovascular death by 38% compared to placebo 1.
Renal Protection and Weight Loss Benefits
Empagliflozin also provides renal protection and modest weight loss benefits (typically 2-3 kg). The DAPA-CKD trial showed that dapagliflozin, another SGLT2 inhibitor, reduced the risk of a composite of sustained decline in eGFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes by 32% compared to placebo 1.
Side Effects and Contraindications
Common side effects of Empagliflozin include genital yeast infections and urinary tract infections, while rare but serious side effects include diabetic ketoacidosis and Fournier's gangrene. Empagliflozin should be used cautiously in patients with renal impairment (not recommended if eGFR is below 30 ml/min/1.73m²) and is contraindicated during pregnancy.
Clinical Use
The medication works by blocking glucose reabsorption in the proximal tubule of the kidney, causing glucose to be excreted in urine rather than returned to circulation, thereby lowering blood glucose levels independently of insulin action. As such, Empagliflozin can be used in patients with type 2 diabetes mellitus, including those with established cardiovascular disease or at high risk of cardiovascular events, to improve glycemic control and reduce the risk of cardiovascular and renal complications.
Key points to consider when prescribing Empagliflozin include:
- Starting dose: 10 mg once daily
- Titration: can be increased to 25 mg daily if needed
- Contraindications: pregnancy, eGFR below 30 ml/min/1.73m²
- Monitoring: renal function, glucose control, and potential side effects
- Benefits: improved glycemic control, reduced risk of cardiovascular and renal complications, and modest weight loss.
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
Empagliflozin in Type 2 Diabetes Mellitus
Empagliflozin, also known as Jardiance, is a sodium glucose cotransporter-2 (SGLT2) inhibitor used in the treatment of type 2 diabetes mellitus (T2DM) [ 3 ]. The role of empagliflozin in managing T2DM is multifaceted, including:
- Glycemic Control: Empagliflozin has been shown to reduce HbA1c levels in patients with T2DM, particularly when used as an add-on to existing antidiabetes treatment [ 3 ].
- Cardiovascular Benefits: The EMPA-REG OUTCOME study demonstrated that empagliflozin reduced the risk of major adverse cardiovascular events (MACE) by 14% relative to placebo, as well as reduced the risk of cardiovascular death by 38% and death from any cause by 32% [ 4, 5 ].
- Renal Protection: Empagliflozin has been associated with reduced risk of hospitalization for heart failure and renal adverse events [ 4 ].
Key Findings
Some key findings from clinical trials include:
- Empagliflozin is effective in reducing HbA1c levels, with adjusted mean treatment differences versus placebo ranging from -0.42% to -0.68% [ 3 ].
- Empagliflozin is generally well-tolerated, with common adverse events including genital mycotic infections [ 4, 6 ].
- Empagliflozin has been shown to reduce body weight and blood pressure, with moderate reductions in systolic blood pressure (-2.9 to -5.2 mm Hg) [ 7 ].
Clinical Use
Empagliflozin is approved for the treatment of adults with T2DM in several countries, including the EU, USA, and Japan [ 6 ]. It can be used as monotherapy or in combination with other antidiabetic agents, and has been shown to be effective in patients with T2DM and established cardiovascular disease [ 4, 5 ].