When managing type 2 diabetes, the options for medications that offer weight loss as a potential benefit can be overwhelming. Two prominent medications in this category are Jardiance (empagliflozin) and Ozempic (semaglutide). While both have shown promise in aiding weight loss, their mechanisms, effectiveness, and usage differ significantly. This article breaks down the options, helping you make an informed decision for your health and confidently select the best fit for your diabetes management journey.
What are Ozempic and Jardiance?
Ozempic and Jardiance are prescribed to manage Type 2 diabetes mellitus and have been approved by the Food and Drug Administration (FDA) to manage blood sugar (glucose) levels. Although both medications can help stabilize blood sugar levels, they differ in various ways, such as different mechanisms of action, dosage form, active ingredient, and potential side effects.
Ozempic: A GLP-1 Receptor Agonist
Ozempic (semaglutide) belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. It is an effective medication for controlling high blood sugar levels in those with type-2 diabetes. Ozempic works by mimicking GLP-1, a hormone encoded in the body after food intake. This hormone helps to lower blood glucose levels by increasing insulin production and secretion and slowing gastric emptying. Ozempic is administered through a subcutaneous injection once a week.
Jardiance: An SGLT2 Inhibitor
Jardiance (empagliflozin) is an SGLT2 inhibitor. It is also intended to control high blood sugar levels in patients with type 2 diabetes. SGLT2 inhibitors work by inhibiting Sodium-Glucose Co-Transporter 2 (SGLT2), a protein in the kidneys. SGLT2 helps reabsorb glucose into the blood. By hindering this protein’s function, Jardiance allows for more glucose to be excreted in urine, helping to lower blood glucose levels.
Though both Ozempic and Jardiance are used to manage high blood sugar levels in patients with type 2 diabetes, their mechanisms of action are distinctly different.
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How Do They Work for Weight Loss?
Jardiance: Excreting Excess Glucose
Jardiance belongs to a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors. It works by preventing glucose reabsorption in the kidneys, causing excess glucose to be excreted through urine. By increasing the amount of glucose excreted in the urine, people can see improved blood glucose, some weight loss, and small decreases in blood pressure.
Ozempic: Appetite Regulation
Ozempic, on the other hand, is a glucagon-like peptide-1 (GLP-1) receptor agonist. It mimics a hormone that targets areas of your brain involved in appetite regulation, helping you feel full sooner and for longer. This reduction in appetite leads to lower calorie intake, promoting weight loss.
Weight Loss Effectiveness: How Much Can You Expect to Lose?
Both medications have been shown to aid in weight loss, but the extent of their effectiveness varies.
Jardiance: Modest Weight Loss
Clinical studies indicate that patients taking Jardiance can expect to lose about 4 to 6 pounds after six months of treatment. The weight-loss results with Jardiance are steady but limited. Over about six months, people lost an average of 3% of their starting weight. Jardiance causes moderate weight loss. Studies have shown that Jardiance reduces weight to a similar extent as the oral Ozempic called Rybelsus. This showed a reduction of roughly 8.1 lbs within 26 weeks of taking the medication.
Ozempic: Significant Weight Loss
Ozempic has been more directly associated with weight loss. Studies reveal that patients using Ozempic can lose significantly more weight compared to those on Jardiance. In general, those who take a high dose of Ozempic (1.0 mg per week) will lose 9.9 - 14.0 lbs within 26-40 weeks of taking the medication.
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Additional Health Benefits
While weight loss is a significant concern, both medications offer additional health benefits that might influence your choice.
Jardiance: Cardiovascular and Kidney Protection
Jardiance is particularly noted for its cardiovascular benefits. It has been shown to reduce the risk of cardiovascular death in patients with Type 2 diabetes and established heart disease. Moreover, it is thought to reduce the risk of kidney disease progression, cardiovascular death, and hospitalization for heart failure. It can also confer kidney-protective benefits and slow the progression of kidney disease in those with type 2 diabetes, a welcome benefit as kidney disease is a common complication of the condition.
Ozempic: Cardiovascular Benefits and Glycemic Control
Ozempic also offers cardiovascular benefits, including a reduction in major adverse cardiovascular events like heart attack or stroke. Additionally, it helps with glycemic control and has a favorable impact on cholesterol levels.
Side Effects: What to Watch Out For
Jardiance’s most common side effects include urinary tract infections and yeast infections due to the increased glucose in the urine. Some patients might also experience dehydration, especially if they do not maintain adequate fluid intake. Ozempic’s side effects are often related to its impact on the gastrointestinal system. These can include nausea, vomiting, diarrhea, and constipation, especially when starting the treatment. However, these symptoms often decrease over time.
Common Side Effects of Ozempic
For Ozempic, some common side effects include nausea, vomiting, diarrhea, and abdominal pain. Serious side effects are possible with either drug, including serious allergic reactions and low blood sugar (hypoglycemia). The most common side effects of Ozempic are nausea, vomiting, diarrhea, constipation, and stomach pain-some of these side effects are reported in more than 10% of recipients. Many of these side effects are a direct result of its mechanism of action, and patients are not advised to initiate on a high dose of Ozempic; instead, they should only progress to an increased dose when tolerance is demonstrated. Given the nature of its route of administration, Ozempic may also cause some minor injection site reactions.
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Common Side Effects of Jardiance
On the other hand, Jardiance may cause urinary tract infections, increased thirst, urinary frequency, and dehydration due to increased urination. Jardiance’s side effects include urinary tract infections and vaginal yeast infections. Serious side effects are possible with either drug, including serious allergic reactions and low blood sugar (hypoglycemia).
Less Common but Severe Side Effects
For example, Ozempic can cause kidney damage, pancreatitis, or reactions at the injection site. There’s also a small chance it could cause a type of thyroid tumor in some people. Jardiance, on the other hand, could cause ketoacidosis (a dangerous level of ketones in the blood), severe urinary tract infections, and may increase cholesterol levels. Notably, both Ozempic and Jardiance may lead to hypoglycemia, especially if taken with other diabetes medications. It’s important for patients to report any side effects to their healthcare provider.
Important Side Effects to Be Aware Of
Jardiance®:
- Increased urination, urinary tract infections, and genital yeast infections are most common since the drug encourages sugar to leave through urine.
- Serious urinary tract infections (UTIs): Signs include burning with urination, fever, pelvic or back pain, or blood in the urine.
- Ketoacidosis: Symptoms include nausea, vomiting, stomach pain, unusual tiredness, or trouble breathing-even if your blood sugar isn’t very high.
- Dehydration and low blood pressure: Watch for dizziness, fainting, or difficulty standing.
- Low blood sugar (hypoglycemia): More likely if you take Jardiance with insulin or other diabetes medicines. Signs include shakiness, sweating, rapid heartbeat, or confusion.
- Fournier’s gangrene: A rare but severe genital infection marked by fever, pain, redness, or swelling.
Ozempic®:
- Digestive issues such as nausea, vomiting, diarrhea, constipation, or stomach pain are common when starting or increasing the dose.
- Pancreatitis: Symptoms include severe abdominal pain that may radiate to the back, with or without vomiting.
- Vision changes: Signs include sudden or significant eyesight issues.
- Low blood sugar (hypoglycemia): Watch for dizziness, shakiness, blurred vision, fast heartbeat, or jitteriness-especially if combined with other diabetes medications.
- Kidney problems: if you experience decreased urination, swelling in the ankles or legs, fatigue, or shortness of breath, get immediate medical attention.
- Gallbladder problems: Symptoms include upper abdominal pain, fever, jaundice, or clay-colored stools.
- Allergic reaction: Signs include swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; or a rapid heartbeat.
Administration: Oral Tablet vs. Weekly Injection
Jardiance is taken as an oral tablet, usually once daily in the morning, with or without food. This convenience can be a significant factor for many patients. Ozempic is administered via a weekly subcutaneous injection, usually injected into the abdomen, thighs, or upper arms. While the idea of self-injecting can be scary, the once-weekly schedule is often more convenient than daily medications.
The dosing schedules of both Ozempic and Jardiance are different and can influence a patient’s preference and adherence to medication. Ozempic is prescribed as a once-weekly injection and is usually started at a lower dose of 0.25mg for four weeks, followed by an increase to 0.5mg. Optionally, the dosage can increase to 1mg if additional blood sugar control is needed. On the other hand, Jardiance is a pill taken orally once daily in the morning with or without food. It comes in two strengths, 10 mg or 25 mg, and the doctor will typically start the patient on the lower strength before adjusting as required. The choice between a once-weekly injectable versus a daily oral medication can significantly affect a patient’s medication adherence. Some may prefer taking a pill daily over weekly injections, while others may find a once-weekly injection more convenient.
Cost Comparison: What to Expect
The costs for Ozempic and Jardiance can vary depending on the specific type of health insurance a patient has. Prices can also fluctuate based on location, form, and quantity purchased per prescription fill. On average, the out-of-pocket cost of Ozempic without insurance can range from $800 to $900 for a one-month supply. Jardiance, in comparison, is generally lower, averaging around $600 to $700 for a one-month supply without insurance. Many patient assistance programs and coupons are available from both manufacturers-Novo Nordisk for Ozempic and Boehringer Ingelheim for Jardiance-that could offset some of these costs if patients qualify. Both drugs are considered brand-name medications, and currently, there’s not a generic form available for either, so patients may find them more expensive than other alternatives.
Cost Without Insurance
- Jardiance®: Has a list price of about $630 per month.
- Ozempic®: Averages around $997 per month without insurance, regardless of the dosage strength.
Insurance Coverage
- Jardiance®:
- Private insurance: Most commercial plans cover Jardiance when prescribed for diabetes, heart failure, or kidney disease. Copays typically range from $0 to $50 per month, depending on the plan.
- Medicaid: Most state programs cover Jardiance for approved conditions, with copays as low as $0 to $8 per month, though amounts vary by state.
- Ozempic®:
- Private insurance: Coverage is possible for type 2 diabetes, but rare for weight loss.
- Medicare: Part D plans cover Ozempic for diabetes, certain cardiac, or kidney conditions, but not for weight loss.
- Medicaid: Most states cover Ozempic for diabetes, with copays typically between $1 and $5, though weight loss coverage is very limited.
- VA and TRICARE: The VA will cover Ozempic only for diabetes under CHAMPVA.
Effectiveness in Blood Sugar Control
Both Ozempic and Jardiance have been proven effective in controlling blood sugars in those with type 2 diabetes. However, their effectiveness varies based on several factors, including individual patient response and the medications’ unique mechanisms of action. Ozempic has demonstrated robust efficacy in reducing HbA1c (average blood sugars over the past 3 months), with some studies suggesting it may reduce HbA1c by up to 1.8%. Jardiance has also shown efficacy in reducing HbA1c, albeit generally to a lesser extent, with an average reduction of around 0.7%.
Considerations for Kidney Issues
Both Ozempic and Jardiance are used in patients with type 2 diabetes, including those with kidney disease. However, they do have unique impact on kidney function because of their mechanisms of action. Research suggests that Jardiance might have a beneficial impact on kidney-related outcomes. It is believed to slow the progression of kidney disease in those with type 2 diabetes. On the other hand, Ozempic has not shown a detrimental impact on kidney function. Recent studies have also suggested potential renal benefits, such as reducing albuminuria (a marker of kidney disease), although more research is required in this area. It’s important to note that these medications aren’t suitable for everyone with kidney disease. Also, dosage adjustments may be necessary in patients with significantly reduced kidney function.
Combining Ozempic and Jardiance
Typically, Ozempic and Jardiance can be taken together to manage blood sugar levels if monotherapy does not yield the desired results. As they have different mechanisms of action, they can act on various aspects of glucose regulation and possibly offer a more comprehensive approach to blood sugar control. Adding a medication like Jardiance to Ozempic therapy could provide additional cardiovascular benefits, particularly in those with heart failure or a high risk of cardiovascular disease. However, this combination therapy may increase the risk of potential side effects.
Who Should Not Take Ozempic or Jardiance?
Choosing a medication should always be individualized, considering a person’s health history, current conditions, and their lifestyle. Certain people should be cautious about using Ozempic or Jardiance.
Contraindications for Ozempic
Ozempic is not recommended for individuals with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (genetic disorders that increase the risk of certain tumors). It is also not advised for those with severe gastrointestinal disease or with hypersensitivity to semaglutide or any of its components.
Contraindications for Jardiance
Jardiance, on the other hand, should not be used in individuals with severe kidney disease or dialysis-dependent kidney failure, severe urinary tract infections, or a history of ketoacidosis. It is also not for people with hypersensitivity to empagliflozin. Pregnant women or those planning to become pregnant should discuss with their health care provider before starting either of these medications.
Unique Benefits of Each Medication
While both Ozempic and Jardiance aim to control blood sugars in those with type-2 diabetes, they offer unique benefits.
Ozempic: Robust Blood Sugar Control and Weight Loss
Ozempic has been highlighted for its robust impact on blood sugar control and promoting weight loss. Its once-weekly dosing can also be convenient for those who struggle to remember daily medication doses. Besides, it has shown potential cardiovascular benefits in reducing the risk of major cardiovascular events such as heart attack, stroke, and cardiovascular death.
Jardiance: Cardiovascular and Kidney Benefits
Jardiance is known for its cardiovascular benefits - particularly for reducing the likelihood of hospitalizations due to heart failure. It can also confer kidney-protective benefits and slow the progression of kidney disease in those with type 2 diabetes, a welcome benefit as kidney disease is a common complication of the condition. As an oral medication, it might be more appealing to those wary of injections.
Direct Comparison: Semaglutide vs. Empagliflozin
In an indirect IPD meta-regression analysis of patients with T2D whose disease was inadequately controlled on background metformin monotherapy, OW semaglutide 1 mg was superior to OD empagliflozin 25 mg in reducing HbA1c and lowering body weight from baseline to end-of-treatment at ~1 year. Complementary analyses supported these findings.
- HbA1c Reduction: OW semaglutide 1 mg significantly lowered mean HbA1c vs empagliflozin 25 mg, by 1.44%-point vs 0.83%-point, respectively (estimated treatment difference [ETD]: −0.61%-point [95% confidence interval (CI): −0.72; −0.49]; P < 0.0001; Fig. 3a).
- Body Weight Reduction: OW semaglutide significantly reduced mean body weight vs OD empagliflozin: 5.29 kg vs 3.64 kg, respectively (ETD: −1.65 kg [95% CI: −2.22; −1.08]; P < 0.0001; Fig. 3b).
- HbA1c Targets: A significantly greater proportion of patients on OW semaglutide vs OD empagliflozin achieved clinically relevant HbA1c targets of <7.0% (69.1% vs 39.3%; odds ratio [OR]: 4.37 [95% CI: 3.33; 5.74]; P < 0.0001) and ≤6.5% (54.2% vs 19.0%; OR: 5.99 [95% CI: 4.46; 8.05]; P < 0.0001; Table 4).
- Other Measures: OW semaglutide provided significantly greater reductions than OD empagliflozin in BMI, waist circumference, total cholesterol, LDL-C (all P < 0.0001) and triglycerides (P < 0.01), whereas OD empagliflozin provided significantly greater reductions than OW semaglutide in diastolic blood pressure (P < 0.05) and significantly greater increases in HDL-C (P < 0.01; Table 5).