Empagliflozin

Empagliflozin, sold under the trade name Jardiance among others, is a medication used together with diet and exercise to treat type 2 diabetes. It is less preferred than metformin and sulfonylureas. It may be used together with other medications such as metformin or insulin. It is not recommended for type 1 diabetes. It is taken by mouth. Empagliflozin, sold under the trade name Jardiance among others, is a medication used together with diet and exercise to treat type 2 diabetes. It is less preferred than metformin and sulfonylureas. It may be used together with other medications such as metformin or insulin. It is not recommended for type 1 diabetes. It is taken by mouth. Common side effects include urinary tract infections, fungal infections of the groin, and joint pains. Rarer but more serious side effects include a skin infection of the groin called Fournier's gangrene and a form of diabetic ketoacidosis with normal blood sugar levels. Use in pregnancy and breastfeeding is not recommended. Use is not recommended in those with significant kidney disease, though it may help slow the progression of mild kidney problems. Empagliflozin is an inhibitor of the sodium glucose co-transporter-2 (SGLT-2), and works by increasing sugar lost in the urine. Empagliflozin was approved for medical use in the United States in 2014. A month supply in the United Kingdom costs the NHS about £ 36.59 as of 2019. In the United States the wholesale cost of this amount is about US$ 442. In 2016 it was the 289th most prescribed medication in the United States with more than a million prescriptions. Empagliflozin is used in combination with proper diet and exercise to help people with type 2 diabetes lower their blood sugar levels. It can be used alongside other medications for type 2 diabetes such as metformin, sulfonylureas, and insulin. When compared against a placebo, empagliflozin led to a drop of 0.7% in hemoglobin A1c, a long-term marker of blood glucose levels. Empagliflozin causes moderate reductions in blood pressure and body weight. These effects are likely due to the excretion of glucose in the urine and a slight increase in urinary sodium excretion. In clinical trials, patients taking empagliflozin lost an average of 2% of their baseline body weight. A higher percentage of people taking empagliflozin achieved weight loss greater than 5% from their baseline. The medication reduced systolic blood pressure by 3 to 5 millimeters of mercury (mmHg). The effects on blood pressure and body weight are generally viewed as favorable, as many patients with type 2 diabetes have high blood pressure or are overweight or obese. SGLT2 inhibitors, including empagliflozin, appear to reduce the likelihood of hospitalization for heart failure or progression of chronic kidney disease in persons with type 2 diabetes. Empagliflozin may reduce the likelihood of death due to cardiovascular causes in people with type 2 diabetes who have known cardiovascular disease. One concern regarding the trial on which these claims are based is that the different arms received different amounts of other medications; thus, the reduced risk cannot necessarily be attributed to empaglifozin. In some countries it has also been approved to reduce the risk of death from cardiovascular causes in people with type 2 diabetes and heart disease. Guidelines by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) recommend SGLT-2 inhibitors like empagliflozin as second-line medications after metformin for type 2 diabetes in people with heart failure or chronic kidney disease. For type 2 diabetes with established cardiovascular disease, the guidelines recommend either a SGLT-2 inhibitor or a GLP-1 agonist as second-line medications after metformin. In all other type 2 diabetes cases, SGLT-2 inhibitors like empagliflozin can be appropriate second-line options if blood glucose control or weight loss are treatment priorities. They are less appropriate if cost is a major factor. In the United Kingdom empagliflozin is typically only recommended together with metformin if a sulfonylurea cannot be taken. Empagliflozin is not recommended for type 1 diabetes. One trial has studied its use in addition to insulin in people with type 1 diabetes. The medications delivered modest improvements in blood glucose control and body weight but were associated with an increased risk of diabetic ketoacidosis, a dangerous complication of diabetes. At this time, empagliflozin is not approved by the US FDA for use in type 1 diabetes.