Can Jardiance (Empagliflozin) be used to optimize glucose management in a patient with a regimen of long and short-acting insulin?

Using Jardiance (Empagliflozin) with Insulin Regimens for Glucose Management

Jardiance (empagliflozin) can effectively optimize glucose management in patients on long and short-acting insulin regimens by reducing HbA1c, promoting weight loss, and decreasing total daily insulin requirements. 1

Efficacy of Jardiance with Insulin Therapy

• When added to insulin therapy (with or without metformin), Jardiance 10 mg and 25 mg daily provides statistically significant reductions in HbA1c compared to placebo, with adjusted mean differences of -0.6% and -0.7% respectively after 18 weeks 1
• The glucose-lowering effect is maintained long-term, with significant HbA1c reductions still evident at 78 weeks of treatment 1
• Jardiance works through an insulin-independent mechanism by inhibiting reabsorption of glucose in the kidney, making it complementary to insulin therapy 2

Benefits Beyond Glycemic Control

• Jardiance reduces total daily insulin dose by approximately 12-13% when added to insulin regimens, which may help minimize insulin-related side effects 1
• Patients on Jardiance with insulin experience significant weight reduction (2.4-3.0% decrease from baseline after 78 weeks) compared to weight gain often seen with insulin intensification alone 1
• Blood pressure reductions are also observed, with systolic blood pressure decreasing by approximately 3-4 mmHg 3

Dosing Considerations

• For patients already on insulin therapy, Jardiance can be initiated at either 10 mg or 25 mg once daily 1
• No insulin dose adjustment is required when initiating Jardiance, but insulin doses may need to be reduced as treatment continues to avoid hypoglycemia 1
• Insulin regimens (both basal and bolus components) should be monitored and adjusted based on self-monitoring of blood glucose levels 4

Special Considerations for MDI Insulin Users

• In patients using multiple daily injections (MDI) of insulin with total daily doses >60 IU, adding Jardiance 10 mg or 25 mg provides significant HbA1c reductions (-0.9% and -1.0% respectively) compared to placebo (-0.5%) 1
• For patients on MDI insulin regimens, Jardiance provides additional benefits in reducing body weight over 52 weeks (approximately -2 kg) 1

Safety Considerations and Monitoring

• When adding Jardiance to insulin therapy, patients should be monitored for hypoglycemia, although the risk is not significantly increased compared to insulin alone 1, 2
• Genital mycotic infections are more common with Jardiance and patients should be counseled about this risk 3
• Blood glucose monitoring should continue as previously recommended based on the insulin regimen, with potential for reducing monitoring frequency if glycemic targets are consistently met 4

Contraindications and Precautions

• Jardiance should not be mixed directly with insulin in the same syringe 4
• Patients with severe renal impairment (eGFR <30 mL/min/1.73 m²) show limited glycemic benefit from Jardiance 1
• Patients should be monitored for volume depletion, especially if also taking diuretics 3

Practical Implementation

• When adding Jardiance to an insulin regimen, maintain the current insulin dosing initially, then adjust insulin doses based on blood glucose monitoring results 1
• After 18 weeks of Jardiance treatment, insulin doses can be adjusted to achieve target glucose levels 1
• For patients on both basal and prandial insulin, both components may need adjustment as Jardiance affects both fasting and postprandial glucose levels 4

By incorporating Jardiance into insulin regimens, clinicians can potentially improve glycemic control while reducing insulin requirements and addressing common comorbidities like obesity and hypertension in patients with type 2 diabetes.