Empagliflozin (Jardiance): A Novel SGLT2 Inhibitor for the Treatment of Type-2 Diabetes.

Diabetes mellitus is a lifelong condition requiring continuous medical care. Type-2 diabetes mellitus (T2DM), which accounts for approximately 90% to 95% of all diagnosed diabetes, is a progressive disease resulting from an insulin secretory defect characterized by insulin resistance and some degree of insulin deficiency.1 Chronic long-term hyper glycemia associated with diabetes causes serious complications, including blindness, kidney failure, amputations, and death. The incidence of diabetes has increased dramatically in the United States over the last three decades, from 5.6 million cases to 21 million diagnosed cases in 2012. If this trend continues, one in three Americans will be diagnosed with diabetes by 2050.2,3 The prevalence of T2DM has a tremendous impact on obesity, which is a growing problem for America’s health care system. Because of the rise in obesity, there is a heightened demand for researchers to develop drug therapies that are effective in treating hyperglycemia as well as promoting weight loss.2 Despite current available therapies, about 50% of U.S. patients are unable to achieve their goals for glycosylated hemoglobin (HbA1c).4 Metformin, a biguanide, is the preferred oral hypoglycemic agent for initial therapy in patients with T2DM. A majority of patients will progress to combination therapy involving other oral agents or insulin to be taken with metformin.5 Metformin is the preferred medication because it has high efficacy in reducing HbA1c levels by 1.5 to 2 percentage points and fasting plasma glucose (FPG) levels by 60 to 80 mg/dL, as well as reducing plasma triglyceride levels and low-density lipoprotein-cholesterol levels by 8% to 15%.6 Due to declining beta-cell function, the majority of those who have initial success with metformin will eventually require one or more additional agents to achieve their treatment goals. The American Diabetes Association recommends that if patients do not achieve the goal of an HbA1c of less than 7% after maximal metformin and lifestyle changes for three months, additional therapy is indicated.7 Several options for further oral therapy exist. Agents that can be added to metformin include: sulfonylureas, thiazolidinediones, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and insulin. Patient preference determines the second-line treatment choice of medications after metformin; the decision should be individualized depending on the degree of hyperglycemia present, the patient’s risk for hypoglycemia, the patient’s body mass index, and the risk for further weight gain.6 Empagliflozin (Jardiance, Boehringer Ingelheim), an SGLT2 inhibitor, is part of the newest class of oral hypoglycemic agents, which includes canagliflozin (Invokana, Janssen) and dapagliflozin (Farxiga, AstraZeneca/Bristol-Myers Squibb). In August 2014, empagliflozin became the most recent medication in its class to be approved by the Food and Drug Administration. Empagliflozin has a low side-effect profile when used in combination with other anti diabetic medications.8 There is little risk of hypoglycemia with empagliflozin because the mechanism of action is independent of beta-cell function and insulin pathway.5 Empagliflozin is indicated for the improvement of glycemic control in conjunction with diet and exercise in adults with type-2 diabetes mellitus.8