Understanding the Mechanism: SGLT2 Inhibition
Jardiance, with the active ingredient empagliflozin, belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. The SGLT2 proteins are located in the kidney tubules and are normally responsible for reabsorbing approximately 90% of the glucose that is filtered from the blood. In individuals with type 2 diabetes, these transporters work overtime, contributing to high blood sugar levels. Jardiance works by blocking the action of these SGLT2 proteins.
When Jardiance blocks SGLT2, the kidneys are unable to reabsorb as much glucose and sodium back into the blood. Instead, the excess glucose is filtered out of the body and excreted through the urine. This process is known as glycosuria. By increasing the excretion of glucose, Jardiance effectively reduces blood sugar levels and HbA1c in patients with type 2 diabetes. This process also causes a mild diuretic effect, as the excretion of sodium and fluid is increased.
Beyond Blood Sugar: Effects on the Cardiovascular System
Jardiance's effects extend far beyond simple blood sugar control. Clinical trials have demonstrated significant cardiovascular benefits, leading to its approval for use in patients with heart failure, even those without type 2 diabetes.
Protecting the heart in diabetes
In adults with type 2 diabetes and established cardiovascular disease, Jardiance reduces the risk of cardiovascular death. This is due to its cardioprotective effects, which are thought to be related to its impact on fluid balance and reduced strain on the heart. By lowering blood pressure and volume, the medication lessens the workload on the heart, ultimately reducing the risk of heart attacks and strokes.
Aiding in heart failure management
For patients with heart failure, Jardiance has been shown to reduce the risk of hospitalization and cardiovascular death. It improves the heart’s ability to pump blood effectively throughout the body by reducing sodium and fluid retention. This mechanism is distinct from its blood sugar-lowering effect, allowing it to benefit patients with and without diabetes who suffer from heart failure.
Kidney Protection with Jardiance
Chronic kidney disease (CKD) is a common complication of diabetes and cardiovascular disease. Jardiance has proven beneficial in slowing the progression of kidney disease and reducing the risk of kidney failure in adults with CKD.
Slowing the decline of kidney function
Jardiance helps protect the kidneys by reducing the reabsorption of sodium and glucose in the renal tubules. Studies have shown that it can preserve higher kidney function over time compared to a placebo. This protective effect is evident in patients with and without diabetes, marking a major advancement in CKD treatment.
Secondary Effects and Side Effects
As with any medication, Jardiance produces several secondary effects and potential side effects that patients should be aware of.
Common side effects
- Increased Urination: Due to the increased excretion of glucose and sodium through the kidneys, patients may urinate more frequently, sometimes waking up during the night.
- Genital Yeast Infections: The presence of more glucose in the urine can create a favorable environment for fungal growth in the genital area. This can cause itching, swelling, or discharge.
- Urinary Tract Infections (UTIs): Like yeast infections, UTIs can occur more often due to the higher glucose levels in the urine.
- Dehydration: The increased fluid loss through urination can lead to dehydration, especially if not managed with adequate fluid intake.
Serious side effects
- Ketoacidosis: A serious condition where the body produces high levels of ketones, causing the blood to become too acidic. This can be life-threatening and may occur even with moderately high blood sugar levels.
- Fournier's Gangrene: A very rare but severe bacterial infection of the genital area that requires immediate medical attention.
- Hypoglycemia: While the risk is low when Jardiance is used alone, it increases significantly when combined with insulin or sulfonylureas.
- Amputations: Studies on the SGLT2 inhibitor class have shown an increased risk of lower limb amputations, particularly in patients with a history of vascular problems or foot complications.
Comparison of Jardiance with Metformin
| Feature | Jardiance (Empagliflozin) | Metformin |
|---|---|---|
| Mechanism | Blocks SGLT2 protein in kidneys to excrete glucose in urine. | Increases cells' sensitivity to insulin and decreases liver glucose production. |
| Drug Class | SGLT2 inhibitor. | Biguanide. |
| Primary Use | Type 2 diabetes; also approved for heart failure and CKD. | First-line treatment for type 2 diabetes. |
| Cardiovascular Benefit | Proven to reduce risk of cardiovascular death and hospitalization. | No direct cardioprotective mechanism; risk reduction related to diabetes control. |
| Weight Effect | Can lead to modest weight loss. | Can cause modest weight loss. |
| Risk of Hypoglycemia | Low risk when used alone; higher risk with insulin/sulfonylureas. | Low risk when used alone; higher risk with insulin/sulfonylureas. |
| Kidney Effect | Protects kidney function and slows CKD progression. | Does not provide the same direct kidney protection. |
| Common Side Effects | UTIs, genital yeast infections, increased urination. | Diarrhea, nausea, stomach upset. |
Important Drug Interactions
Patients should inform their healthcare provider of all medications and supplements they take, as Jardiance can interact with certain drugs.
- Diuretics (water pills): Taking Jardiance with diuretics can increase the risk of dehydration and low blood pressure due to increased fluid excretion.
- Insulin and Sulfonylureas: The risk of hypoglycemia is higher when Jardiance is combined with other blood sugar-lowering medications like insulin and sulfonylureas. Your doctor may need to adjust the dosages.
- Lithium: Jardiance may lower the effectiveness of lithium by increasing its clearance from the body. Close monitoring of lithium levels is required.
Conclusion
Jardiance (empagliflozin) is a multi-faceted medication that fundamentally changes how the body handles glucose and sodium via the kidneys. While primarily a treatment for type 2 diabetes, its documented benefits for cardiovascular and kidney health make it a vital tool for managing complex health issues. By forcing the excretion of excess sugar and salt, it not only lowers blood glucose but also reduces the workload on the heart and preserves kidney function. Understanding both its profound benefits and potential side effects, such as the increased risk of infections and dehydration, is key for patients considering this treatment. As always, patients should consult their healthcare provider to determine if Jardiance is the right course of action for their individual health needs.
For more detailed information, consult the official prescribing information on the DailyMed website.
