Living with Type 2 diabetes mellitus presents numerous challenges, with many individuals also grappling with being overweight or other co-existing medical conditions. In response to these challenges, medications like Jardiance have emerged as a tool in managing blood sugar levels and offering potential weight loss benefits. This article delves into the relationship between Jardiance and weight loss, exploring its mechanisms, benefits, risks, and alternative options.
Understanding Jardiance
Jardiance, containing the active ingredient empagliflozin, belongs to a class of drugs known as sodium-glucose cotransporter-2 (SGLT2) inhibitors. These medications lower blood glucose by prompting the kidneys to remove sugar from the body through urine. The Food and Drug Administration (FDA) approved Jardiance in 2014 for treating type 2 diabetes. Beyond diabetes management, it is also prescribed to reduce the risk of cardiovascular death in adults with cardiovascular disease in addition to type 2 diabetes and to reduce the risk of hospitalization and cardiovascular death in certain adults with heart failure.
How Jardiance Works
The kidneys play a crucial role in maintaining the balance of electrolytes and molecules like glucose in the body. They filter glucose from the bloodstream, allowing excess glucose to be removed through urine. However, SGLT2 receptors in the kidneys reabsorb some glucose back into the bloodstream. Jardiance inhibits these SGLT2 receptors, preventing glucose reabsorption and leading to more glucose being excreted in the urine. This process helps lower blood sugar levels in individuals with type 2 diabetes, independent of the effects of insulin. Sodium-glucose cotransporters are responsible for glucose reabsorption in the kidney. SGLT2 inhibitors, such as Jardiance, block these transporters, so excess glucose is not reabsorbed into the bloodstream and is excreted in the urine.
The Link Between Jardiance and Weight Loss
Weight loss can be a side effect of SGLT2 inhibitors. A stable weight is maintained by balancing caloric intake and energy expenditure, such as when exercising. In Type 2 diabetes, excess calories, in the form of glucose, can lead to fat deposition around the internal organs, such as the liver and pancreas, and in muscle tissue. While Jardiance is not specifically FDA-approved for weight loss, clinical studies have demonstrated its potential to aid in weight reduction, particularly for individuals with Type 2 diabetes who are also overweight or obese.
Clinical Evidence of Weight Loss
Controlled clinical studies show some variability regarding the amount of SGLT2 inhibitor-induced weight loss. A recently published clinical study investigated the effect of Jardiance on weight loss in patients with prediabetes or Type 2 diabetes who were not using other glucose-lowering diabetes medications. In studies, adult patients taking the 10 mg dose of Jardiance (empagliflozin) had an average weight loss of 2.8% from their baseline weight (their weight at the start of the study). Those receiving the 25 mg tablet had an average weight loss of 3.2% of their baseline weight. In a 24-week study of people with type 2 diabetes, those taking Jardiance® lost an average of about 3% of their starting body weight.
Read also: Comparing Jardiance and Ozempic
Mechanisms Behind Weight Loss
Jardiance is not an appetite suppressant, i.e., it does not make one feel less hungry. Instead, SGLT2 inhibitors promote an average of 75 grams of glucose excretion in the urine per day, which is about 300 excess calories. Jardiance causes your body to flush out some of the sugar you eat, so you don’t end up absorbing those calories. Over time, that can create an energy deficit. Research shows this adds up to about 240 to 400 calories a day lost through urine.
Impact of Modest Weight Loss
While the weight loss associated with Jardiance may seem modest, even a small reduction in weight can have significant health benefits. According to the American Diabetes Association’s (ADA) Diabetes Prevention Program, every two pounds of weight loss is associated with a significant reduction in the likelihood of progressing to Type 2 diabetes. Even modest weight loss can significantly improve glucose homeostasis and reduce metabolic cardiovascular risk factors in type 2 diabetes patients.
Additional Benefits of Jardiance
Beyond its potential for weight loss, Jardiance offers several other health benefits, particularly for individuals with type 2 diabetes and related conditions.
Blood Sugar Control
By inhibiting the SGLT2 receptor, Jardiance increases the amount of sugar you excrete in urine, improving blood sugar levels for individuals with type 2 diabetes. In clinical trials, Jardiance also led to statistically significant reductions in A1C and fasting plasma glucose, measures of blood sugar control, when compared to an inactive placebo. In clinical studies, Jardiance improved blood sugar levels in adults with diabetes. After 24 weeks of treatment, people taking Jardiance had the following results: Hemoglobin A1c (HbA1c) levels were lowered by 0.7 percent to 0.8 percent. Fasting blood sugar levels were lowered by 19 mg/dL to 25 mg/dL.
Blood Pressure Reduction
Jardiance can modestly reduce blood pressure by acting as a diuretic, reducing fluid volume and blood vessel resistance. As a result, it eases the workload on the heart and benefits patients with heart failure. Jardiance is not specifically FDA-approved to reduce blood pressure, but a positive effect was seen in 24-week clinical trials.
Read also: Comparing Rybelsus and Jardiance
Cardiovascular Protection
Jardiance offers significant cardiovascular benefits, lowering the risk of major adverse cardiovascular events like heart attack and stroke in individuals with type 2 diabetes and established cardiovascular disease. While the exact mechanisms are not fully understood, improvements in blood vessel function may play a role. In a three-year clinical study, Jardiance helped reduce the risk of cardiovascular death by 38 percent in people with both type 2 diabetes and heart disease. In this study, people took Jardiance in combination with other treatments for diabetes and heart disease. Jardiance can also have a positive effect on heart (cardiovascular) and kidney outcomes in adults and lower the risk for hospitalization or a heart-related death.
Kidney Protection
Jardiance has been shown to slow the progression of kidney disease, a common complication of prolonged type 2 diabetes, by reducing blood glucose levels and mitigating inflammation and oxidative stress. In individuals with known cardiovascular disease or kidney impairment, SGLT2 inhibitors can also help prevent cardiovascular death from heart attack or heart failure and stabilize some forms of kidney disease.
Risks and Side Effects of Jardiance
While Jardiance offers numerous benefits, it's essential to be aware of the potential risks and side effects associated with its use.
Common Side Effects
As with most medicines, common side effects can occur, including genital yeast infections and urinary tract infections. Jardiance is usually well-tolerated in patients with type 2 diabetes. In studies in children 10 years and older, the risk of hypoglycemia (low blood sugar) was higher with Jardiance whether or not they used insulin. The more common side effects of Jardiance can include: urinary tract infections, with symptoms such as burning while urinating, urinating more often, and cloudy urine vaginal yeast infections, with symptoms such as itching, soreness, and pain while urinating. If you have symptoms of these infections, call your doctor. You may need treatment with over-the-counter or prescription medications.
Serious Side Effects
Serious side effects from Jardiance aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following: Hypotension (low blood pressure). Symptoms can include: lightheadedness feeling dizzy or falling when standing up clammy skin loss of consciousness depression Kidney damage. Symptoms can include: decreased urination swelling in legs and ankles confusion fatigue Increased low-density lipoprotein cholesterol levels Other serious side effects, explained in more detail below in “Side effect details,” include: Ketoacidosis (buildup of ketones in the body, causing your blood to be too acidic) Serious urinary tract infections (including urosepsis and pyelonephritis) Fournier’s gangrene (severe infection near the genitals) Genital yeast infection Serious allergic reactions
Read also: Type 2 Diabetes Treatment
Specific Risks to Consider
- Increased Risk of Infections: Jardiance may increase the risk of genital yeast infections and urinary tract infections. Jardiance increases the amount of sugar you excrete through urination. As a result, the sugar in the urinary tract can allow more bacteria to grow. Good hygiene and hydration can help mitigate this risk.
- Dehydration and Low Blood Pressure: Jardiance's diuretic effect can lead to increased urination, potentially causing dehydration and low blood pressure, particularly in older adults or those taking other diuretics. Drinking plenty of water and monitoring for symptoms like dizziness are crucial.
- Ketoacidosis: Since clinical studies ended, ketoacidosis has been reported in some people taking Jardiance. People with ketoacidosis have abnormally high amounts of ketones (a type of protein) in their body. Your body typically makes ketones after breaking down fat from your diet. Jardiance causes your body to make more ketones. A buildup of ketones in the body can cause the blood to be too acidic. Ketoacidosis can be life threatening and requires immediate medical treatment.
- Fournier’s Gangrene: Jardiance has a rare side effect called necrotizing fasciitis of the perineum (Fournier’s gangrene). This is a rare, life-threatening infection caused by bacteria entering the layer of tissue just under the skin in the perineum, the space between the anus and scrotum in men, and the anus and vulva in women.
Who Can Take Jardiance?
Jardiance is typically prescribed for individuals with type 2 diabetes to help manage blood sugar levels effectively. Additionally, it's used for those diagnosed with heart failure, offering benefits such as lowering blood pressure and protecting the heart. These conditions often result in elevated average blood glucose levels (HbA1c) and weakened heart function.
Off-Label Use for Weight Loss
With obesity affecting up to 500 million people worldwide and several drugs approved by the FDA to treat obesity, healthcare providers are turning to off-label drug use for their patients. Yes, Jardiance can help patients with type 2 diabetes lose weight, but this is not an approved use. If Jardiance is used off-label for weight loss, it is important to follow medical advice and be mindful of side effects while taking the medication.
Alternatives to Jardiance for Weight Loss
If weight loss is a primary goal, there are other medications that are more effective for weight management that are worth exploring. Several medications used in diabetes management promote weight loss through various mechanisms.
Metformin
Metformin, a biguanide medication, is often the first-line medication used to treat Type 2 diabetes. Metformin-associated weight loss occurs via several mechanisms, including a reduction in glucose production in the liver, a reduction in insulin production, and changes in appetite. Yes, you may lose weight if you are taking metformin in combination with Jardiance. In a 24-week long clinical study with over 600 adults, Jardiance given as add-on therapy to metformin significantly improved weight loss.
GLP-1 Receptor Agonists
Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 receptor agonists mimic the structure of naturally occurring hormones in the body called incretins. GLP-1 receptor agonists stimulate the release of insulin from the pancreas in response to a meal, helping reduce the amount of circulating glucose in the blood. Liraglutide is used to treat Type 2 diabetes and for non-diabetic weight loss. It is sold under the brand names Victoza and Saxenda. Victoza is a lower dose of medication used in the management of Type 2 diabetes. Saxenda is a higher dose of medication that has been FDA-approved for weight loss in obesity. Trulicity (dulaglutide) is also a GLP-1 receptor agonist that is FDA-approved for treating Type 2 diabetes, along with diet and exercise. Although not FDA-approved for weight loss, the results of the AWARD-11 clinical trial show that the weight loss effects from Trulicity occur in a dose- and body-mass-dependent fashion. Semaglutide is manufactured under the brand name Ozempic for Type 2 diabetes management and the brand name Wegovy when used exclusively for weight loss. Semaglutide is a GLP-1 receptor agonist administered in an injectable pen dosed once weekly. Tirzepatide is another GLP-1 receptor agonist administered in an injectable pen that is dosed once per week. It is manufactured under the brand name Mounjaro for Type 2 diabetes management and the brand name Zepbound when used for weight loss. In a large head-to-head comparison study of tirzepatide and semaglutide, tirzepatide was associated with significantly greater weight loss than semaglutide.
Other Weight Loss Medications
Other medications that stimulate weight loss include:
- Topiramate: By altering GABA and Glutamate channels in the brain, topiramate can effectively suppress cravings and appetite.
- Bupropion: Working as a neurotransmitter reuptake inhibitor for norepinephrine and dopamine, bupropion increases their concentrations in the brain, thereby altering hunger and mood.
- Naltrexone: Acting as a mu-receptor antagonist, naltrexone suppresses appetite and cravings by inhibiting the effects on the hypothalamic-pituitary-adrenal axis.
- Orlistat: This medication functions as a lipase inhibitor, preventing the breakdown of fats in the intestines and resulting in their excretion in stool.
Dosage and Administration
Jardiance is an oral tablet taken once-a-day in the morning, with or without food, and is used in addition to diet and exercise. Your doctor may adjust your dose so always follow their directions.
Standard Dosage
The recommended starting dosage of Jardiance in people with type 2 diabetes is 10 mg once daily. It should be taken in the morning with or without food. If Jardiance is effective for you, your doctor may increase your dosage. The maximum dosage of Jardiance is 25 mg per day. The recommended starting dosage of Jardiance in people with heart failure is 10 mg once daily. It should be taken in the morning with or without food.
Important Considerations
- Kidney Function: Because Jardiance works through your kidneys, your provider will keep an eye on your kidney health.
- Upcoming Surgery or Illness: Sometimes Jardiance needs to be paused for a surgery or if you’re fasting for a procedure.
- Missed Dose: If you miss a dose, take it as soon as you remember, but only if it’s not close to your next scheduled dose. Don’t take two doses at once to make up for a missed one.
- Discontinuation: You shouldn’t stop taking Jardiance without talking to your healthcare provider first.
Lifestyle Modifications
Medications used to treat Type 2 diabetes should be used in addition to significant lifestyle changes, including strategies to lower weight and increase exercise and exercise tolerance. Proper compliance is required to obtain the maximum Jardiance weight loss effects. There is substantial data demonstrating that low-calorie diets and short-term use of very low-calorie diets are extremely beneficial to individuals with Type 2 diabetes. Exercising regularly is known to increase the rate of fat oxidation and provide protection against all-cause mortality in individuals with Type 2 diabetes. When weight loss is a primary goal, and for all individuals with Type 2 diabetes, alcohol consumption should be limited. A balanced diet and regular activity help Jardiance work more effectively. Limiting refined carbs and focusing on lean proteins, high-fiber foods, and healthy fats can help stabilize blood sugar and support gradual weight loss.
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