How effective is Jardiance (Empagliflozin) for blood sugar control in type 2 diabetes?

Effectiveness of Jardiance (Empagliflozin) for Blood Sugar Control in Type 2 Diabetes

Jardiance (empagliflozin) is highly effective for blood sugar control, reducing HbA1c by approximately 0.7-0.9% compared to placebo, with 35-44% of patients achieving HbA1c <7% at the standard 10-25mg daily dosing. 1

Glycemic Efficacy

• Jardiance as monotherapy provides statistically significant reductions in HbA1c (p-value <0.0001) and fasting plasma glucose compared to placebo 1
• The 10mg daily dose reduces HbA1c by approximately 0.7% from baseline, while the 25mg daily dose reduces it by approximately 0.8% 1
• Jardiance's glucose-lowering effect is observed across various patient subgroups including different genders, races, geographic regions, baseline BMI, and disease durations 1
• When added to metformin and sulfonylurea in patients with inadequate control, empagliflozin 10mg and 25mg reduced HbA1c by 0.82% and 0.77% respectively compared to placebo (0.17% reduction) 2

Mechanism of Action and Advantages

• Empagliflozin works through an insulin-independent mechanism by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidney, reducing glucose reabsorption and promoting urinary glucose excretion 3
• This unique mechanism provides several advantages:
  • Low risk of hypoglycemia when used as monotherapy 3
  • Can be used in combination with other antidiabetic medications with complementary mechanisms 3
  • Effective regardless of beta-cell function or insulin resistance status 3

Comparative Effectiveness

• The American Diabetes Association includes SGLT2 inhibitors like empagliflozin as one of the recommended options for add-on therapy when metformin alone is insufficient 4
• In the treatment algorithm, empagliflozin can be considered after metformin, with selection based on patient-specific factors 4
• For patients with established cardiovascular disease or high cardiovascular risk, empagliflozin is recommended independent of A1C levels due to its cardiovascular benefits 4

Dosing Considerations

• Standard dosing is 10mg once daily, which can be increased to 25mg daily if needed for additional glycemic control 5
• Dose adjustments are required based on renal function:
  • For eGFR ≥45 mL/min/1.73m², no dose adjustment is required 4
  • For eGFR <45 mL/min/1.73m², empagliflozin is not recommended for glycemic control (though it may still be used for cardiovascular or renal benefits) 5
  • For eGFR <20 mL/min/1.73m², empagliflozin should not be initiated 5

Benefits Beyond Glycemic Control

• Weight reduction of approximately 2-3% from baseline 1
• Systolic blood pressure reduction of 2.6-3.4 mmHg 1
• Cardiovascular benefits with reduction in cardiovascular death and hospitalization for heart failure 5
• Renal protection by slowing eGFR decline in patients with diabetic kidney disease 5

Safety Considerations

• Most common adverse effects include:
  • Genital mycotic infections, particularly in women 5
  • Urinary tract infections 5
  • Risk of volume depletion, especially when used with diuretics 5
• Rare but serious adverse effects to monitor:
  • Euglycemic diabetic ketoacidosis 4
  • Consider discontinuing at least 3 days before scheduled surgery 5

Practical Recommendations

• Start with the 10mg daily dose for most patients 5
• Monitor renal function before and periodically during treatment 5
• Consider empagliflozin particularly for patients who need additional glycemic control while also benefiting from weight loss and blood pressure reduction 3
• For patients with type 2 diabetes and established cardiovascular disease, empagliflozin offers mortality benefits beyond glycemic control 3

Jardiance is FDA-approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus and to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease 1.