Does Jardiance (Empagliflozin) 25mg improve Hemoglobin A1c (HbA1c) levels better than Farxiga (Dapagliflozin) 10mg?

Direct Comparison: Jardiance 25 mg vs Farxiga 10 mg for A1C Reduction

Jardiance (empagliflozin) 25 mg and Farxiga (dapagliflozin) 10 mg produce similar A1C reductions of approximately 0.5-0.8%, with no clinically meaningful difference in glycemic efficacy between these two SGLT2 inhibitors at their respective doses. 1, 2

Expected A1C Reduction with Each Agent

Jardiance (Empagliflozin) 25 mg

• Empagliflozin 25 mg reduces A1C by approximately 0.5-0.8% when added to existing therapy, depending on baseline glycemic control and renal function 1
• In patients with baseline A1C around 8%, empagliflozin produces a moderate glucose-lowering effect with HbA1c reduction of about 0.5% more than placebo 3
• The 25 mg dose performs best among different empagliflozin doses when considering both efficacy (HbA1c, fasting plasma glucose) and safety, particularly after long-term use ≥12 weeks 4
• Network meta-analysis shows the ranking order for lowering HbA1c is: 25 mg > 50 mg > 10 mg > 5 mg > 1 mg 4

Farxiga (Dapagliflozin) 10 mg

• Dapagliflozin 10 mg reduces A1C by approximately 0.5-1.0% in patients with type 2 diabetes 1
• In patients with poorly controlled diabetes (baseline A1C ≥9%), dapagliflozin 10 mg decreased A1C by 1.39% versus 0.65% with placebo at 24 weeks 2
• In patients with baseline A1C ≥10%, dapagliflozin 10 mg reduced A1C by 1.59% versus 0.82% with placebo 2

Key Clinical Context

Why These Agents Are Equivalent for Glycemic Control

Both SGLT2 inhibitors are considered to have moderate glucose-lowering potency, with each new class of non-insulin agent added to metformin generally lowering A1C by approximately 0.7-1.0% 1. The American Diabetes Association acknowledges that empagliflozin produces a moderate glucose-lowering effect, particularly when compared to GLP-1 receptor agonists 1.

Impact of Renal Function on Efficacy

The glucose-lowering effect of empagliflozin decreases substantially with declining renal function 1:

• eGFR 60 to <90 mL/min/1.73 m²: A1C reduction of -0.6%
• eGFR 45 to <60 mL/min/1.73 m²: A1C reduction of -0.5%
• eGFR 30 to <45 mL/min/1.73 m²: A1C reduction of -0.2%

Empagliflozin should not be used for glycemic control when eGFR <45 mL/min/1.73 m² due to decreased efficacy 1. Similar renal-dependent efficacy applies to dapagliflozin 5.

Clinical Decision-Making Algorithm

When to Choose Based on Glycemic Efficacy Alone

Neither agent has a clinically meaningful advantage over the other for A1C reduction at these doses 1, 2. The choice should be based on:

1. Cardiovascular and renal indications: Both agents have cardiovascular and renal benefits independent of glucose-lowering effect 1, 3
2. Patient's renal function: Use is appropriate down to eGFR ≥25 mL/min/1.73 m² for cardiovascular/renal protection, but glycemic efficacy diminishes below eGFR 45 1
3. Cost and formulary considerations: These often drive the practical choice between equivalent agents
4. Tolerability profile: Both have similar adverse event profiles including genital infections and volume depletion 3, 2

Important Caveats

If the primary goal is glycemic control alone, consider that GLP-1 receptor agonists are positioned above SGLT2 inhibitors in treatment hierarchies due to greater glycemic potency 1. Many patients will require combination therapy with GLP-1 receptor agonists, SGLT2 inhibitors, and metformin to achieve glycemic goals 1.

When adding either SGLT2 inhibitor to patients already on insulin or sulfonylureas, reduce the insulin dose by approximately 20% or wean/stop the sulfonylurea to prevent hypoglycemia 1.

The cardiovascular and renal benefits of these agents are independent of their glucose-lowering effect, and they are recommended for patients with type 2 diabetes and established cardiovascular disease regardless of baseline A1C level 1, 3.