From the Guidelines
Jardiance (empagliflozin) carries a low risk of hypoglycemia when used alone, but the risk significantly increases when combined with insulin or insulin secretagogues, emphasizing the need for careful management and monitoring. The risk of hypoglycemia with Jardiance is primarily a concern when it is used in combination with other diabetes medications that increase insulin levels or action, such as insulin or sulfonylureas 1. To manage this risk, patients should monitor their blood glucose levels regularly, especially when starting Jardiance or adjusting doses of concurrent diabetes medications.
Key Considerations for Managing Hypoglycemia Risk with Jardiance
- Patients should be educated about the symptoms of hypoglycemia, which include shakiness, sweating, confusion, and irritability.
- Carrying fast-acting carbohydrates like glucose tablets is recommended for quick treatment of hypoglycemia.
- Healthcare providers may need to reduce insulin or sulfonylurea doses when initiating Jardiance therapy to mitigate the risk of hypoglycemia.
- Regular follow-up appointments are crucial to adjust medication regimens as needed and to monitor for any signs of hypoglycemia or its consequences.
Patient Groups at Higher Risk
- Elderly patients
- Those with renal impairment
- Individuals with irregular eating patterns
Mechanism of Action and Hypoglycemia Risk
Jardiance works by increasing urinary glucose excretion through SGLT2 inhibition in the kidneys, a mechanism that is independent of insulin action, which explains its low intrinsic hypoglycemia risk 1. However, when combined with medications that increase insulin levels or action, the glucose-lowering effects become additive, potentially causing blood glucose to drop too low. Therefore, careful consideration and monitoring are necessary when Jardiance is used in combination with other diabetes therapies.
From the FDA Drug Label
Hypoglycemia Inform patients that hypoglycemia has been reported when JARDIANCE is used with insulin secretagogues or insulin. Hypoglycemia may occur in pediatric patients regardless of concomitant antidiabetic treatment. Educate patients or caregivers on the signs and symptoms of hypoglycemia [see Warnings and Precautions (5. 4)].
The risk of hypoglycemia with Jardiance (Empagliflozin) is present, particularly when used with insulin secretagogues or insulin. To manage this risk, patients should be educated on the signs and symptoms of hypoglycemia. Key points to consider:
- Hypoglycemia may occur in pediatric patients regardless of concomitant antidiabetic treatment.
- Patients should be instructed to report any symptoms of hypoglycemia to their healthcare provider.
- Healthcare providers should consider the risk of hypoglycemia when prescribing Jardiance, especially in patients taking insulin or insulin secretagogues 2.
From the Research
Risk of Hypoglycemia with Jardiance (Empagliflozin)
- The risk of hypoglycemia with Jardiance (Empagliflozin) is considered low due to its insulin-independent mechanism of action 3.
- As an SGLT2 inhibitor, empagliflozin works by reducing glucose reabsorption in the kidneys, which lowers blood glucose levels without increasing insulin production, thereby reducing the risk of hypoglycemia.
Management of Hypoglycemia
- Professional caregivers, patients, and their families should be educated about hypoglycemia prevention, including symptom recognition and the necessity of rapid treatment 4.
- Appropriate selection and titration of therapeutic agents, including insulin analogs with more predictable time-action profiles, can reduce hypoglycemia risk 4.
- Patient education about hypoglycemia prevention, including behavioral modification and the importance of frequent blood glucose monitoring, should accompany all therapeutic interventions 4.
Empagliflozin and Hypoglycemia in Clinical Trials
- In clinical trials, empagliflozin has been shown to improve glycemic control and weight in type 1 diabetes without increasing hypoglycemia 5.
- Severe hypoglycemia was rare and the frequency was similar between empagliflozin and placebo in the EASE trials 5.
- The use of empagliflozin as an adjunct to insulin therapy in type 1 diabetes has been evaluated in the EASE trials, which demonstrated its safety and efficacy in improving glycemic control and reducing weight 5.
General Recommendations for Hypoglycemia Management
- Structured diabetes education programs are recommended for individuals at high risk for hypoglycemia 6.
- The use of real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps is conditionally recommended for individuals with type 1 diabetes at high risk for hypoglycemia 6.
- Glucagon preparations that do not require reconstitution are recommended for managing severe outpatient hypoglycemia in adults and children 6.