Is there a glucose benefit with Jardiance (Empagliflozin) 25mg in patients with Impaired renal function, specifically those with an estimated glomerular filtration rate (eGFR) of 30?

From the Guidelines

Jardiance (empagliflozin) 25 mg is not recommended for glucose control when eGFR is below 30 mL/min/1.73m². At this level of kidney function, the glucose-lowering effect of Jardiance becomes minimal because the medication works by blocking glucose reabsorption in the kidneys, which requires adequate kidney function to be effective 1. While Jardiance may still provide cardiovascular and kidney benefits even at lower eGFR levels (as low as 20 mL/min/1.73m²), these benefits are not related to glucose control 1. For patients with eGFR below 30, other diabetes medications such as insulin, GLP-1 receptor agonists, or DPP-4 inhibitors would be more appropriate for managing blood glucose 1. If you have an eGFR of 30, you should discuss with your healthcare provider about potentially adjusting your diabetes medication regimen to ensure effective glucose control while protecting your kidney function.

Some key points to consider:

• The glucose-lowering effect of SGLT2 inhibitors, including Jardiance, is reduced in patients with lower eGFR levels 1.
• Jardiance may still provide cardiovascular and kidney benefits even at lower eGFR levels, but these benefits are not related to glucose control 1.
• Other diabetes medications, such as insulin, GLP-1 receptor agonists, or DPP-4 inhibitors, may be more effective for managing blood glucose in patients with eGFR below 30 1.
• Patients with eGFR below 30 should discuss their diabetes medication regimen with their healthcare provider to ensure effective glucose control and protect their kidney function.

It's essential to prioritize the patient's kidney function and overall health when managing their diabetes medication regimen, and to consider the potential benefits and risks of each medication option 1.

From the FDA Drug Label

The glucose lowering benefit of JARDIANCE 25 mg decreased in patients with worsening renal function.

The glucose benefit of JARDIANCE 25 mg is decreased in patients with an eGFR of 30. The drug's efficacy in lowering glucose levels diminishes as renal function worsens. 2

From the Research

Glucose Benefit with Jardiance 25 mg when eGFR 30

• The studies provided do not directly address the glucose benefit of Jardiance 25 mg in patients with an eGFR of 30 3, 4, 5, 6, 7.
• However, study 5 found that empagliflozin slowed the progression of chronic kidney disease (CKD) in patients with type 2 diabetes and cardiovascular disease, and that the annual mean slope of eGFR change did not decline with empagliflozin during chronic treatment.
• Study 6 found that empagliflozin was associated with a reduced risk of rapid kidney function decline in patients with type 2 diabetes, with a two-third reduction in odds of rapid decline compared to placebo.
• Study 7 found that empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes in patients with chronic kidney disease, including those with an eGFR of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area.
• While these studies suggest that empagliflozin may have beneficial effects on kidney function and cardiovascular outcomes, they do not specifically address the glucose benefit of Jardiance 25 mg in patients with an eGFR of 30.

Kidney Function and Jardiance

• Study 5 found that empagliflozin was associated with a uniform shift in individual eGFR slopes across all periods, and that the annual mean slope of eGFR change did not decline with empagliflozin during chronic treatment 5.
• Study 6 found that empagliflozin was associated with a reduced risk of rapid kidney function decline in patients with type 2 diabetes, with a two-third reduction in odds of rapid decline compared to placebo 6.
• Study 7 found that empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes in patients with chronic kidney disease, including those with an eGFR of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area 7.

Empagliflozin and eGFR

• Study 5 found that empagliflozin slowed the progression of CKD in patients with type 2 diabetes and cardiovascular disease, and that the annual mean slope of eGFR change did not decline with empagliflozin during chronic treatment 5.
• Study 6 found that empagliflozin was associated with a reduced risk of rapid kidney function decline in patients with type 2 diabetes, with a two-third reduction in odds of rapid decline compared to placebo 6.
• Study 7 found that empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes in patients with chronic kidney disease, including those with an eGFR of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area 7.