Type 2 diabetes is a prevalent condition characterized by the body's ineffective use of insulin, leading to elevated blood sugar levels. This occurs when cells become resistant to insulin, a hormone that facilitates glucose absorption. Uncontrolled high blood sugar can result in severe complications such as heart disease, stroke, and kidney failure, underscoring the importance of effective diabetes management. Both Jardiance (empagliflozin) and metformin are prescription drugs used to treat Type 2 diabetes, but they differ in their mechanisms of action, side effects, and additional benefits.
Understanding Type 2 Diabetes
In type 2 diabetes, the body doesn't use insulin properly. Insulin normally helps cells absorb glucose, keeping blood sugar levels in check. In type 2 diabetes, however, cells don't respond well to insulin, a problem known as insulin resistance. Initially, the body produces extra insulin to compensate and maintain normal blood sugar. However, over time, the pancreas may not be able to keep up with the increased demand, leading to elevated blood sugar levels. High blood sugar can cause serious health problems, like heart disease, stroke, and kidney failure. That's why it's crucial to take type 2 diabetes seriously.
Metformin: A First-Line Treatment
Metformin is a widely used prescription medicine for type 2 diabetes and is typically prescribed as a first-line treatment. The drug works in two main ways: it lowers the amount of sugar your liver makes and reduces the sugar absorbed by your intestines. Your liver plays a key role in regulating blood sugar by producing glucose, especially when you haven't eaten. In type 2 diabetes, your liver can produce too much glucose. Besides these effects, Metformin can also influence hormones in the gut and may lead to modest weight loss. Metformin is available in tablet form, with dosages of 500, 850, and 1,000 mg. There are two types of Metformin tablets: immediate-release (IR) and extended-release (ER). Metformin is available both as a brand-name and a generic medication. Typically prescribed as a first-line treatment, Metformin shows improved efficacy when combined with lifestyle changes. If Metformin isn’t effective alone or if you’re managing Type 2 diabetes alongside other health conditions, your doctor may opt to add to your treatment with an additional medication.
Jardiance: An SGLT2 Inhibitor
Jardiance, known as Empagliflozin, is a prescription drug categorized as a sodium-glucose co-transporter 2 (SGLT2) inhibitor. Jardiance targets SGLT2, a protein in your kidneys that reabsorbs glucose back into your bloodstream. By inhibiting SGLT2, Jardiance promotes the excretion of excess glucose through urine, thereby lowering blood sugar levels. Beyond managing blood sugar, Jardiance has shown benefits for heart and kidney health. Jardiance's ability to inhibit sodium reabsorption can improve heart function by making it easier for the heart to pump blood. Jardiance is available in tablet form, with doses of 10 mg and 25 mg. The usual starting dose is 10 mg, taken orally once a day in the morning. Your doctor may increase the dose to 25 mg daily, depending on how well the medication controls your condition. It typically starts working within 30 to 60 minutes, but it may take a few days to several weeks to significantly impact blood sugar levels. Approved by the FDA in 2014 for type 2 diabetes, Jardiance is a relatively new medication. A notable aspect of Jardiance is its proven benefits for patients with heart disease, making it the first in its class to demonstrate such effectiveness.
Weight Loss Effects: Jardiance vs. Metformin
Both Jardiance (empagliflozin) and Metformin are two drugs that are often sought out as opportunities to reduce body weight in patients. While both Type 2 diabetes medications do have some weight loss side effects, they are very different from one another in terms of the way they assist in weight loss.
Read also: Comparing Jardiance and Ozempic
Jardiance and Weight Loss
Clinical trials have also reported weight loss in individuals with type 2 diabetes taking Jardiance. On average, participants saw about a 3% reduction in their initial body weight over about 6 months. As glucose (and calories) are lost through urination, patients lose weight as a side effect. This calorie-wasting mechanism results in modest but consistent weight loss. On average, patients may lose about 2-3% of their body weight over time, depending on individual factors. Weight loss with Jardiance tends to be gradual and may plateau after several months of use. 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.
Metformin and Weight Loss
Metformin’s effect on weight is more indirect than Jardiance, and it’s generally seen as weight-neutral or causing mild weight loss. The weight loss associated with metformin patients is generally attributed to reduced insulin resistance, decreased appetite, and possibly alterations in the gut microbiome. Some studies suggest an average weight loss of about 1-3 kg (2-6 pounds), but this varies by individual. Weight loss with metformin may be more noticeable in patients with insulin resistance or polycystic ovary syndrome (PCOS), but it’s usually not a primary treatment for weight loss.
Comparing the Two
Here’s a comparison overview of Jardiance and Metformin:
| Comparison Metric | Jardiance (Empagliflozin) | Metformin |
|---|---|---|
| Price | Typically ranges from $500 - $600/month (without insurance). Costs can be lower with insurance or patient assistance programs. | Usually $4 - $20/month (generic version). Often considered a low-cost medication. |
| Side Effects | Common: Increased urination, urinary tract infections (UTIs), genital yeast infections, dehydration, low blood pressure. Rare: Diabetic ketoacidosis (DKA), acute kidney injury | Common: Gastrointestinal issues (nausea, diarrhea, stomach upset), metallic taste. Rare: Lactic acidosis (especially in patients with kidney problems), vitamin B12 deficiency |
| Drug Class | SGLT2 Inhibitor (Sodium-glucose co-transporter 2 inhibitor) | Biguanide |
| Drug Application Type | Oral tablet, once daily (sometimes twice daily depending on dose) | Oral tablet (immediate-release: 2-3 times daily, extended-release: once daily) |
| Mechanism of Action | Lowers blood sugar by preventing glucose reabsorption in the kidneys, causing excess glucose to be excreted in urine | Reduces glucose production in the liver and improves insulin sensitivity |
| Impact on Weight | Moderate weight loss due to calorie excretion (2-3% of body weight) | Generally weight-neutral or causes mild weight loss |
| Primary Indications | Type 2 diabetes, Reduces risk of cardiovascular death in patients with diabetes and heart disease, Treats heart failure in patients with or without diabetes | Type 2 diabetes, Used off-label for polycystic ovary syndrome (PCOS) and prediabetes management |
| Cardiovascular Benefits | Shown to reduce risk of heart attack, stroke, and cardiovascular death | Some cardiovascular protection, but not as strong as Jardiance |
| Kidney Impact | Kidney-protective in patients with Type 2 diabetes and kidney disease | Can’t be used in advanced kidney disease due to risk of lactic acidosis |
| Prescription Status | Brand-name only (no generic version available) | Generic available (low-cost option) |
Side Effects and Risks
Jardiance (empagliflozin), as an example, has far greater and larger side effects like ketoacidosis, dehydration, genital infection, and more. These side effects, while rare, are far more extreme than the side effects that Metformin patients experience.
Jardiance
Common side effects of Jardiance include urinary tract infections (8-9%), yeast infections (2-6%), increased red blood cells (3-4%), and increased thirst (2%). Jardiance has fewer reported side effects than metformin. However, Jardiance has the potential to cause dangerously low blood pressure, kidney injury, and serious infections. 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.
Read also: Comparing Rybelsus and Jardiance
Metformin
Common side effects of metformin include gastrointestinal problems like diarrhea (IR tabs 53%, ER tabs 10%), intestinal gas (12%), nausea and vomiting (IR tabs 26%, ER tabs 7%), weakness (9%), and abdominal pain (7%). Metformin is not recommended for those with congestive heart failure, compromised kidney function, poor liver function, or people who may become dehydrated. Having these conditions increases the chance of developing lactic acidosis, a rare but potentially fatal condition linked to metformin use.
Drug Interactions
Some medicines can interact with Jardiance or metformin, possibly affecting the efficacy of the drugs or increasing the risk of side effects. Common drug interactions between Jardiance and metformin include those with insulin and other diabetes medications that can trigger insulin secretion. In essence, taking too much of one or more diabetes medications may overcorrect high blood sugar and lead to dangerously low blood sugar.
Jardiance may also interact with diuretics (drugs that cause urination) as well as ACE inhibitors (e.g., lisinopril) and angiotensin receptor blockers (ARBs) (e.g., losartan), leading to dehydration and low blood pressure. Taking Jardiance with NSAIDs (e.g., ibuprofen, naproxen, etc.) can increase the risk of kidney damage, especially in patients with existing kidney conditions.
Metformin can interact with some drugs, leading to decreased effectiveness, such as corticosteroids (e.g., prednisone) and hormones (e.g., estrogen), while other drugs, such as ACE inhibitors, can increase the effect of metformin potentially causing very low blood sugar levels.
Cost Comparison
Generally speaking, Jardiance (empagliflozin) comes in at a much higher cost than Metformin, usually in the $500 range per month depending on the type of insurance that the patient has. Without insurance, Jardiance costs about $862, and metformin costs about $165 for a 30-day supply. However, drug prices vary. You can use SingleCare coupons to save money on Jardiance, lowering the cost to about $530. However, Metformin comes in at a much lower cost usually in the $9 to $21 range.
Read also: Berberine and Metformin
Combining Jardiance and Metformin
Your doctor might suggest using both together, especially if Metformin alone isn't enough. 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. Weight loss was also significant in a study over 24-weeks long when Jardiance was used in combination with metformin and a sulfonylurea compared to placebo.
Additional Considerations
Alcohol Consumption
Patients who are taking Jardiance should not consume any alcohol as it can increase blood sugar levels in the body, making it more difficult for your kidney to process the glucose levels, increasing the chances of some of the more serious negative side effects that come with Jardiance. However, patients who are taking Metformin can consume lower amounts of alcohol. Patients with any type of Type 2 diabetes should avoid excessive alcohol use. Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can occur depending on amount and frequency of alcohol consumption.
Approved Uses
Ultimately, the FDA has only approved metformin for the treatment of Type 2 diabetes and Jardiance for the treatment of Type 2 diabetes, heart failure, and CKD. Jardiance is also FDA approved for the prevention of cardiovascular disease and end-stage kidney disease in certain populations.