What does glucose in urine indicate for patients taking Jardiance (Empagliflozin)?

Glucose in Urine with Jardiance (Empagliflozin): Expected Mechanism and Clinical Significance

Glucose in urine (glycosuria) is an expected and intended therapeutic effect of Jardiance (empagliflozin) treatment, indicating the medication is working properly by blocking glucose reabsorption in the kidneys.

Mechanism of Action

Jardiance works through a unique mechanism that differs from other diabetes medications:

• Empagliflozin is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that blocks glucose reabsorption in the proximal tubules of the kidneys 1
• This leads to increased urinary glucose excretion (glycosuria), which reduces blood glucose levels independently of insulin action 2
• The medication promotes the excretion of approximately 50-100g of glucose per day in the urine, representing about 200-400 kcal/day 3

Clinical Significance of Glycosuria

Normal and Expected Finding

• Glycosuria is the primary therapeutic mechanism and indicates the medication is working properly
• Unlike traditional diabetes where glucose in urine indicates poor control, with SGLT2 inhibitors it's an expected finding
• The glucose-lowering effect is moderate, typically reducing HbA1c by approximately 0.8% compared to placebo 2

Benefits Beyond Glucose Control

The glycosuria produced by empagliflozin provides several additional benefits:

• Weight reduction (approximately 2 kg) due to caloric loss through urine 2
• Blood pressure reduction (systolic ~4 mmHg, diastolic ~2 mmHg) due to osmotic diuresis 2
• Cardiovascular and renal protection benefits 4

Important Monitoring Considerations

When to Be Concerned

While glycosuria is expected, patients and providers should be vigilant for:

1. Euglycemic Diabetic Ketoacidosis (euDKA):

   • Can occur despite normal or only slightly elevated blood glucose levels
   • Risk factors: acute illness, reduced carbohydrate intake, insulin dose reduction 5
   • Symptoms: nausea, vomiting, abdominal pain, fatigue, trouble breathing 1
   • If suspected, check ketones in urine even if blood glucose is <250 mg/dL 1

2. Volume Depletion:

   • The osmotic diuresis effect can lead to dehydration
   • Monitor for symptoms of hypotension, especially in elderly or fragile patients 3
   • Pay attention to volume status during illness or fasting 6

Sick Day Management

During illness or periods of reduced oral intake:

• Temporarily stop empagliflozin for up to 3 days or until symptoms resolve 6
• Resume medication at usual doses within 24-48 hours of eating and drinking normally 6
• Seek medical assistance if symptoms last >72 hours 6
• Discontinue before scheduled surgery (3-4 days prior), during critical illness, or prolonged fasting 6

Other Considerations

• Genital Mycotic Infections: The glycosuria increases risk of genital infections, particularly in women 6, 3
• Urinary Tract Infections: Slightly increased risk 6
• Renal Function: Glucose-lowering effect is minimal at eGFR <45 mL/min/1.73m² 6
• Medication Interactions: Empagliflozin has minimal clinically significant drug interactions 3

Conclusion

Glucose in urine while taking Jardiance is the expected therapeutic mechanism and indicates proper medication function. Patient education should emphasize that this finding is normal and represents the medication working as intended, while also ensuring awareness of potential complications like euglycemic DKA that require prompt medical attention.