Jardiance A1C Reduction in Type 2 Diabetes
Jardiance (empagliflozin) reduces A1C by approximately 0.7-0.8% when used as monotherapy or add-on therapy in patients with type 2 diabetes. 1
Efficacy Data from Clinical Trials
Monotherapy
- In treatment-naïve patients with baseline A1C of 7.9%, empagliflozin 10 mg reduced A1C by 0.7% and empagliflozin 25 mg reduced A1C by 0.8% compared to placebo at 24 weeks 1
- These reductions were statistically significant (p<0.0001) 1
- Approximately 35% of patients on 10 mg and 44% on 25 mg achieved A1C <7% compared to only 12% on placebo 1
Add-On to Metformin
- When added to metformin (≥1,500 mg/day) in patients with baseline A1C of 7.9-8.1%, empagliflozin 10 mg reduced A1C by 0.70% and 25 mg reduced A1C by 0.77% versus placebo at 24 weeks 2
- Both doses showed significant reductions (p<0.001) 2
Add-On to Other Therapies
- In youth aged 10-17 years with type 2 diabetes, empagliflozin (pooled 10 mg and 25 mg groups) reduced A1C by 0.84% compared to placebo (p=0.012) 3
- The glucose-lowering effect is consistent across various combination therapies including sulfonylureas, pioglitazone, linagliptin, and insulin 1
Factors Affecting A1C Reduction
Baseline Glycemic Control
- The efficacy increases with higher baseline A1C levels 4
- Patients with A1C ≥8.5% may see more robust reductions 3
- The absolute effectiveness of most oral medications, including empagliflozin, rarely exceeds a 1% reduction in A1C 3
Renal Function
- Critical limitation: Efficacy decreases significantly in patients with renal impairment 4, 5
- The glucose-lowering effect depends on adequate kidney function to promote glucosuria 4
- Empagliflozin is not recommended for glycemic control when eGFR <45 mL/min/1.73 m² 3
Additional Metabolic Benefits Beyond A1C
Weight Reduction
- Empagliflozin reduces body weight by approximately 2-2.8% (roughly 2 kg) compared to placebo 1, 4, 2
- This occurs through calorie loss via glucosuria 4
Blood Pressure Reduction
- Systolic BP decreases by approximately 2.6-4 mmHg 1, 4, 2
- Diastolic BP decreases by approximately 2 mmHg 4, 2
- This effect is mediated by osmotic diuresis 4
Fasting Plasma Glucose
- Empagliflozin 10 mg reduced FPG by 19 mg/dL and 25 mg reduced FPG by 25 mg/dL compared to placebo (which increased by 12 mg/dL) 1
Clinical Context and Guidelines
Positioning in Treatment Algorithm
- Metformin remains first-line therapy for most patients with type 2 diabetes 3
- Each new class of non-insulin agent added to metformin generally lowers A1C by approximately 0.7-1.0% 3
- For patients with established cardiovascular disease or high CV risk, empagliflozin is recommended as part of the glucose-lowering regimen independent of A1C level 3
Cardiovascular Benefits
- Empagliflozin has demonstrated cardiovascular benefits beyond glycemic control 3
- It reduces cardiovascular death and hospitalization for heart failure in patients with established ASCVD 3
- These benefits appear independent of the A1C-lowering effect 5
Safety Considerations
Hypoglycemia Risk
- Empagliflozin has no intrinsic risk of hypoglycemia when used alone 6
- Confirmed hypoglycemic events occurred in only 1.4-1.8% of patients on empagliflozin monotherapy versus 0.5% on placebo 2
- Risk increases when combined with insulin or sulfonylureas 3, 6
- No severe hypoglycemia occurred in the pediatric trial 3
Common Adverse Effects
- Genital mycotic infections occur more frequently, especially in women (3.7-4.7% vs 0% placebo) 2, 4
- Urinary tract infections show minimal increase (5.1-5.6% vs 4.9% placebo) 2
- Most adverse events are mild to moderate in intensity 6
Practical Prescribing
Dosing
- Start with empagliflozin 10 mg once daily 3
- Can increase to 25 mg daily if additional glycemic control is needed 1
- For cardiovascular risk reduction, no dose titration beyond 10 mg is necessary 3
- Maximum approved daily dose is 25 mg 3