Duration of Jardiance-Induced Glucosuria
Jardiance (empagliflozin) causes persistent glucosuria (glucose in urine) for as long as you continue taking the medication—it does not stop causing glucosuria over time. This is the intended mechanism of action, not a side effect that resolves. 1, 2
Mechanism and Persistence
Empagliflozin works by continuously blocking SGLT2 transporters in the kidney's proximal tubules, preventing glucose reabsorption and forcing approximately 50-100 grams of glucose per day into the urine. 3, 4, 5
This glucosuria persists throughout treatment and only stops when you discontinue the medication or when kidney function declines significantly. 2, 6
The glucose-lowering effect (and thus glucosuria) is most pronounced when blood glucose is elevated and diminishes as blood glucose normalizes, but some degree of glucosuria continues as long as filtered glucose is available. 2, 4
How Glucosuria Changes Over Time
The amount of glucose in urine depends on two factors: your blood glucose level and your kidney function (eGFR). 2, 5
Based on Blood Glucose:
- When HbA1c is high (around 8%), glucosuria is maximal, resulting in loss of 70-100g glucose daily. 3, 4
- As blood glucose improves toward normal ranges, the amount of glucose filtered and excreted decreases, but glucosuria does not completely stop. 2
Based on Kidney Function:
- At eGFR ≥45 mL/min/1.73 m²: Full glucose excretion effect continues. 2
- At eGFR 30-45 mL/min/1.73 m²: Substantially reduced glucosuria due to less glucose being filtered. 2
- At eGFR <30 mL/min/1.73 m²: Minimal to no glucosuria because very little glucose reaches the tubules to be blocked from reabsorption. 2
Critical Clinical Implications
The persistent glucosuria is therapeutically beneficial but creates ongoing risk for genital mycotic infections (approximately 6% vs 1% placebo), particularly in women, throughout the duration of treatment. 7, 1, 4
Empagliflozin should be continued even when glucosuria diminishes at lower eGFR levels because the cardiovascular and renal protective benefits persist independent of glucose-lowering effects. 7, 1, 2
The medication can be safely continued down to eGFR 20 mL/min/1.73 m² for cardiorenal protection, even though glucose-lowering efficacy (and thus glucosuria) becomes minimal at these levels. 7, 2
Common Pitfall to Avoid
Do not discontinue empagliflozin because you notice persistent glucose in urine—this is the intended mechanism. The drug reduces cardiovascular mortality by 38% and kidney disease progression by 39-44% through effects that extend far beyond glucose lowering, including blood pressure reduction (approximately 4/2 mmHg), weight loss (approximately 2 kg), and direct renal protective effects. 7, 1, 4
The only reason to stop empagliflozin related to its glucosuric effect would be intolerable genital infections despite proper hygiene, or if kidney replacement therapy becomes imminent. 7