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Diabetes is a chronic condition brought on by either insufficient insulin production by the pancreas or inefficient insulin utilization by the body. Insulin is a hormone that controls blood sugar levels. The body’s inefficient use of insulin causes type 2 diabetes, also known as non-insulin-dependent or adult-onset. Type 2 diabetes affects more than 95% of those who have the disease. This particular type of diabetes is primarily brought on by increased body weight and inactivity. The kidneys absorb extra glucose in hyperglycemia, raising the renal glucose threshold and starting a vicious cycle of chronic hyperglycemia.
A better approach to glycemic control
The kidney has become a therapeutic target in the management of type 2 diabetes because it is essential for maintaining glucose homeostasis. 90% of the glucose excreted by the kidney is reabsorbed by SGLT-2 (sodium-glucose cotransporter 2), which is found in the proximal tubule. Inhibition of SGLT-2 increases urine glucose excretion and improves glycemic management. In patients with type 2 diabetes, glycemic control may be improved by the SGLT-2 inhibitors when used in conjunction with diet and exercise. These newer oral diabetes medications work independently of pancreatic B-cell function and insulin resistance by decreasing glucose absorption, decreasing renal glucose threshold, increasing urinary glucose excretion, and reducing hyperglycemia. This technique has the additional advantages of weight loss and blood pressure reduction, as well as a reduced risk of hypoglycemia (low blood sugar).
In the early 1990s, insulin, sulfonylureas, and metformin were the only options available to clinicians for the pharmacological control of type 2 diabetes. Since then, numerous classes of drugs have been developed, authorized, and used in clinical trials. Historically, unless there are contraindications, metformin has been advised as the first-line medication. However, given the accumulating evidence that SGLT-2 inhibitors can lower the risk of heart failure, chronic renal disease, and atherosclerotic cardiovascular disease(ASCVD), there has been a drive to consider taking them instead of metformin. In 2022, the American Diabetes Association recommended that first-line therapy often involves metformin and extensive lifestyle adjustment and is dependent on comorbidities, patient-centered treatment considerations, and management needs. People with type 2 diabetes who also have or are at high risk for atherosclerotic cardiovascular disease (ASCVD), heart failure, and/or chronic kidney disease should start with other drugs, such as SGLT-2 inhibitors, with or without metformin depending on their glycemic demands. Additionally, the American Association of Clinical Endocrinologists (AACE) advises that diabetic therapy be tailored to the particular patient based on characteristics unique to both the patient and the drugs themselves. The patient’s cardiac, cerebral, and renal functions determine the treatment option. Thus, SGLT-2 inhibitors should be used as first-line medications in some individuals, according to the ADA and AACE, who have now reached an understanding of the subject.
An example of an SGLT-2 inhibitor is empagliflozin, also known by the brand name Jardiance. It was approved by the Food and Drug Administration (FDA) in 2014. It is a potent, orally active, selective inhibitor of SGLT-2. It was recommended as an adjunct to diet and exercise in patients with type 2 diabetes to achieve better glycemic control in adults. Jardiance has now been approved to lower the risk of hospitalization and mortality in patients with heart failure and a low ejection fraction, as well as the risk of cardiovascular death in people with type 2 diabetes and preexisting cardiovascular disease.
A randomized, double-blind, international trial compared 2,997 people who received Jardiance (10 mg once daily) to 2,991 participants who received a placebo. The safety and efficacy of Jardiance as a supplement to standard-of-care medication were examined and evaluated. The test subjects received both a placebo and the drug for 2 years. The time until death from cardiovascular factors or the requirement for hospitalization for heart failure served as the primary efficacy measurement. The time until death from cardiovascular factors or the requirement for hospitalization for heart failure served as the primary efficacy measurement. In contrast to 17% of participants who received the placebo, 14% of those who received Jardiance for an average of nearly two years died from cardiovascular causes or were hospitalized for heart failure. Fewer people being admitted to hospitals for heart failure was primarily responsible for this benefit.
Furthermore, another study (EMPRA-REG MET) was carried out with the purpose of comparing the safety, effectiveness, and tolerability of empagliflozin (10 and 25 mg once daily) to a placebo in patients with type 2 diabetes who had insufficient glycemic control for 24 weeks. Also, in an open-label therapy group of patients with poor glycemic control and an HbA1c level of >10% (>86 mmol/mol), the safety and effectiveness of empagliflozin 25 mg were examined. This was a placebo-controlled, randomized, double-blinded Phase III study conducted across 12 countries. A total of 638 patients with a history of metformin use were given a placebo and 10, 25, and 50 mg of empagliflozin. Also, 69 patients with an HbA1c level >10% received open-label empagliflozin 25 mg. On the basis of the result analysis, the empagliflozin groups showed significantly higher reductions in HbA1c levels from baseline than did the placebo group during the 24-week timeframe. Compared to placebo, empagliflozin treatment significantly reduced MDG levels. Changes in baseline fasting plasma glucose (FPG) were recorded; both dosages of empagliflozin significantly reduced FPG levels as compared to placebo at week 24. Furthermore, there were recordings of >5% reductions in body weight and blood pressure (BP) (systolic and diastolic) reductions. In the open-label group, changes in HbA1c levels were recorded. There was a reduction in baseline levels, including FPG, MDG, and BP levels.
Getting Jardiance for cheap
Jardiance has proven to be a lifesaver, some people randomly refer to it as the miracle drug. However, its high cost has left people stuck with cheaper options like metformin. Interestingly, there are online drug stores that offer cost savings on Jardiance, up to 92%. The average retail price in the United States is $ 724 for 30 tablets.
Patients with type 2 diabetes who have not obtained or are unlikely to obtain glycemic control through lifestyle changes are advised to use metformin as their first-line medication. When the disease progresses, metformin alone is typically unable to sustain glycemic control, despite being initially successful. The outcomes of these trials show that adding Jardiance to the regimen or even using it as a single drug therapy improves glycemic control greatly.