Jardiance (Empagliflozin) Offers Cardiovascular and Renal Benefits Alongside Glycemic Control in Type 2 Diabetes

Key Takeaways

Research has shown that Jardiance (Empagliflozin) was associated with fewer hospitalizations and deaths from cardiovascular causes.
Furthermore, participants taking Jardiance achieved better glycemic control compared to placebo.
It offers added protection for patients with heart failure or kidney disease.

Diabetes

Diabetes is a chronic condition resulting from either an insufficient production of insulin by the pancreas or its inefficient utilization by the body. Insulin is a hormone that controls blood sugar levels. When the pancreas is unable to produce insulin, a condition known as type 1 diabetes occurs. However, when your body’s cells fail to respond to insulin despite its production by the pancreas, it is known as type 2 diabetes. Type 2 diabetes is relatively common than type 1 diabetes, and it affects more than 95% of those who have the disease. Both conditions, however, result in high glucose levels. This leads to hyperglycemia.

Normally, your kidneys have proteins that help to reabsorb glucose from the urine back into the blood. Because these proteins use sodium during that reabsorption process, they are known as sodium glucose co-transporters-2 (i.e., SGLT-2). In type 2 diabetes, however, this process becomes too efficient, and more glucose is absorbed into the blood. This starts a vicious cycle of hyperglycemia.

Using SGLT-2 Inhibitors To Achieve Glycemic Control

In the early 1990s, insulin, sulfonylureas, and Metformin were the only options available to clinicians for the pharmacological control of diabetes. However, since then, numerous other classes of drugs have been developed, authorised, and used in clinical trials. Each drug works by its own mechanism.

Historically, unless there are reasons not to give this drug, Metformin is considered the first-line medication. However, in recent times, owing to the understanding of the role of the SGLT-2 in diabetes, these proteins have become a therapeutic target in the management of type 2 diabetes.

Since SGLT-2 worsens the hyperglycemia in diabetes, drugs that have been found to block these proteins have been found to be useful in diabetes. Drugs that act by blocking SGLT-2 are known as SGLT-2 inhibitors.

Aside from their beneficial role in treating diabetes, SGLT-2 inhibitors have also been found to be useful in addressing the co-morbidities that come with diabetes. Generally, co-morbidities are other disease conditions that can be found in a person with a particular disease. Co-morbid conditions that may be found in people with diabetes include, but are not limited to, heart failure, chronic kidney disease, and atherosclerotic cardiovascular disease.

Although metformin is recommended as the first-line pharmacological agent for diabetes according to the 2022 American Diabetes Association, 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.

An example of an SGLT-2 inhibitor is empagliflozin, also known by the brand name Jardiance. This drug was approved by the Food and Drug Administration (FDA) in 2014. 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.

Clinical Evidence Supporting Jardiance

#1 Jardiance Can Help Your Heart: What the Studies Show

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 was considered the primary way of assessing the efficacy of the drugs.

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.

#2 Improvements in Glycemic Control (HbA1c Reduction)

Furthermore, another study by Häring and his colleagues at the University of Tübingen, Germany, 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.

Generally, when glucose levels in the blood increase, the high blood glucose attaches itself to hemoglobin. As a result, the higher the level of glucose in the blood, the higher the percentage of hemoglobin that is attached to glucose (glycated). Glycated hemoglobin is represented by HbA1c

The study considered patients with HbA1c of ≥7% to ≤ 10% (≥53 to ≤86 mmol/mol) while receiving metformin (≥1,500 mg/day). The participants were randomized into three groups. The first group consisted of 217 participants, and these people were given empagliflozin 10 mg. 213 participants made up the second group, and like the first, these participants were also given empagliflozin; however, the dose was 25 mg. A placebo was administered to the third group, and 20 participants made up this group. The drugs were administered over 24 weeks. At the end of the 24 weeks, the participants’ HbA1c levels were measured.

Based on the result analysis, the empagliflozin groups showed significantly higher reductions in HbA1c levels from baseline than the placebo group during the 24-week timeframe. Compared to placebo, where HbA1c only dropped slightly by 0.13%, reductions by 0.70% and 0.77% were recorded in the empagliflozin 10 mg and empagliflozin 25 mg groups, respectively. The reported p-value was less than 0.001. This means that there was less than 0.1% chance that the observed results happened by random chance. Hence, this result was considered significant.

Furthermore, at the end of the 24 weeks, participants who were given empagliflozin showed significantly reduced mean daily sugar as well as systolic and diastolic pressure levels compared to those on placebo.

Are there any observed adverse events with empagliflozin use?

While the findings of this article show that Jardiance is efficacious in the treatment of type 2 diabetes, a few adverse events have been associated with its use. In the study by Häring et al. (2014), on average, adverse events were reported in 58.7% of the participants on placebo, while 49.5-57.1% of the participants who were given empagliflozin experienced adverse events. These adverse events included confirmed hypoglycemia, urinary tract infections, and genital infections. The study observed that 0.5%, 1.8%, and 1.4% of the participants on placebo, empagliflozin 10 mg, and empagliflozin 25 mg, respectively, experienced confirmed hypoglycemic adverse events. Similarly, urinary tract infections were reported in 4.9%, 5.1%, and 5.6% of the patients, while genital infections were seen in 0%, 3.7%, and 4.7% of the participants, respectively.

FAQs

What is Jardiance?
A once-daily pill that lowers blood sugar by helping the kidneys remove excess glucose in urine.

How does it help with type 2 diabetes?
It improves blood sugar control and reduces risks of heart failure and kidney disease.

Is it better than metformin?
Not better, but often used together. Jardiance is preferred in patients with heart or kidney risks.

Can Jardiance be a first-line treatment?
Yes, especially for people with cardiovascular disease or chronic kidney issues.

How well does it lower A1c?
It lowers HbA1c by about 0.7–0.8% in most patients over 24 weeks.

What are common side effects?
Urinary and genital infections, increased urination, and rarely, low blood sugar.

Does it cause weight loss?
Yes, modest weight loss is a common benefit.

Is it safe for people with kidney disease?
Yes, in mild to moderate cases. It’s used to slow kidney decline in diabetes.

How fast does it work?
Blood sugar improvements start within days; heart and kidney benefits build over time.

Can it cause low blood sugar?
Rarely on its own, but risk increases with insulin or sulfonylureas.

Who should avoid it?
People with type 1 diabetes, ketoacidosis history, or very low kidney function.

Is Jardiance expensive?
It can be, but discount cards and insurance often lower the cost.

Do I need a prescription?
Yes, Jardiance is a prescription-only medication.

Final Thoughts

The management of type 2 diabetes has evolved significantly in recent years, moving beyond agents that address the condition to also include newer agents that also address common comorbidities. Jardiance (empagliflozin) is in this group of drugs. Jardiance is an SGLT-2 inhibitor that has been found to offer cardiovascular and renal protection in addition to improving glycemic control.

As a result, Jardiance represents a promising option in the care of type 2 diabetes. It is therefore beneficial for patients who not only require better blood sugar control but also need to manage associated cardiovascular or kidney risks. As always, treatment decisions should be guided by a healthcare provider.

References

Cavaiola, T. S., & Pettus, J. H. (2022, July 28). Management Of Type 2 Diabetes: Selecting Amongst Available Pharmacological Agents. Nih.gov; MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK425702/

Fala, L. (2015). Jardiance (Empagliflozin), an SGLT2 Inhibitor, Receives FDA Approval for the Treatment of Patients with Type 2 Diabetes. American Health & Drug Benefits, 8(Spec Feature), 92. https://pmc.ncbi.nlm.nih.gov/articles/PMC4665046/

Häring, H.-U., Merker, L., Seewaldt-Becker, E., Weimer, M., Meinicke, T., Broedl, U. C., Woerle, H. J., & EMPA-REG MET Trial Investigators. (2014). Empagliflozin as add-on to metformin in patients with type 2 diabetes: a 24-week, randomized, double-blind, placebo-controlled trial. Diabetes Care, 37(6), 1650–1659. https://doi.org/10.2337/dc13-2105