From the Guidelines
Jardiance (empagliflozin) is not a DPP-4 inhibitor, but rather an SGLT2 inhibitor, which has been shown to reduce the risk of heart failure hospitalizations and cardiovascular death in patients with type 2 diabetes. The mechanism of action of Jardiance is distinct from DPP-4 inhibitors, as it works by preventing glucose reabsorption in the kidneys, causing excess glucose to be excreted in urine 1. In contrast, DPP-4 inhibitors, such as sitagliptin, linagliptin, saxagliptin, or alogliptin, work by increasing incretin hormones to stimulate insulin release and reduce glucagon secretion.
The benefits of SGLT2 inhibitors, including Jardiance, in reducing heart failure hospitalizations and cardiovascular death have been consistently demonstrated in several large outcomes trials, including EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, and CREDENCE 1. Additionally, the DAPA-HF trial showed that dapagliflozin, another SGLT2 inhibitor, reduced the risk of worsening heart failure and cardiovascular death in patients with heart failure with reduced ejection fraction, regardless of the presence or absence of type 2 diabetes 1.
In contrast, the use of DPP-4 inhibitors has not been associated with a significant reduction in heart failure hospitalizations or cardiovascular death, and may even increase the risk of heart failure hospitalization, as seen with saxagliptin 1. The American College of Physicians recommends adding an SGLT2 inhibitor, such as Jardiance, to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control, to reduce the risk of all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure 1.
Key points to consider when prescribing Jardiance include:
- Its mechanism of action as an SGLT2 inhibitor, which is distinct from DPP-4 inhibitors
- Its benefits in reducing heart failure hospitalizations and cardiovascular death in patients with type 2 diabetes
- Its potential to promote modest weight loss and blood pressure reduction
- The recommendation to use SGLT2 inhibitors, such as Jardiance, in adults with type 2 diabetes and inadequate glycemic control, to reduce the risk of cardiovascular events and progression of chronic kidney disease 1.
From the Research
Role of Jardiance (Empagliflozin)
- Jardiance (Empagliflozin) is not a DPP-4 (Dipeptidyl Peptidase-4) inhibitor, but rather a sodium glucose cotransporter-2 (SGLT2) inhibitor 2, 3, 4, 5
- Empagliflozin is used in the treatment of type 2 diabetes, and has been shown to have a moderate glucose-lowering effect 6
- The drug has been found to reduce mortality in patients with type 2 diabetes and significant cardiovascular risk factors, primarily due to a reduction in cardiovascular mortality, particularly due to heart failure 6, 4
Cardiovascular Benefits
- Empagliflozin has been shown to reduce the risk of major adverse cardiovascular events, including cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke 3, 4
- The drug has also been found to reduce the risk of hospitalization for heart failure and all-cause admission to hospital 3, 4
- The cardiovascular benefits of empagliflozin are thought to be independent of its glucose-lowering effect, and may be due to its diuretic effect and ability to reduce blood pressure 6, 2
Safety and Tolerability
- Empagliflozin is generally well tolerated, but can cause adverse effects such as genital infections, kidney failure, and diabetic ketoacidosis 6, 2
- The drug may also be hepatotoxic, and there is a potential risk of cancer, particularly bladder cancer 6
- Empagliflozin can interact with other medications, including nephrotoxic drugs, and can cause volume depletion and a fall in blood pressure, especially when co-administered with other diuretics or antihypertensive drugs 6