Type-2 diabetes mellitus is a progressive disease that results from an insulin secretory defect and is characterized by some degree of insulin deficiency and insulin resistance.
It accounts for more than 90 percent of diabetes cases diagnosed and affects over 30 million people in the United States.
In Europe, T2DM affects about 57 million people. By the year 2035, its prevalence is expected to increase to 70 million Europeans.
Type 2 diabetes mellitus is more likely to occur in people who are physically inactive and overweight and most commonly develops in adulthood.
Symptoms
Common symptoms of T2DM include:
- blurred vision;
- being more thirsty than usual;
- itching and skin infections;
- slow-healing wounds;
- feeling lethargic and tired;
- passing more urine.
Causes
With type 2 diabetes mellitus, the pancreas does not produce enough insulin for the body’s increased needs and the cells don’t respond to insulin properly.
Risk Factors
Risk factors for developing type 2 diabetes mellitus include:
- cigarette smoking;
- women who have had gestational diabetes;
- people taking certain corticosteroid medications or antipsychotic medications;
- unhealthy eating habits, like – regularly choosing high-fat, low-fiber foods, or high-salt;
- women with polycystic ovary syndrome;
- low levels of physical activity;
- all people with cardiovascular disease;
- being overweight or obese.
Treatment
Several classes of anti-diabetic drugs are prescribed to lower blood sugar levels, including:
- bile acid sequestrants;
- sulfonylureas – they work by increasing the insulin released by the pancreas;
- SGLT2 inhibitors – they block the reabsorption of glucose in the kidneys;
- biguanides – they work to lower blood glucose levels;
- DPP-4 inhibitors – they work by helping a compound called GLP-1 stay active in the body longer;
- thiazolidinediones – they reduce glucose production in the liver and also help your body to use insulin better;
- meglitinides – they stimulate the release of insulin.
Here is a comparison between Jardiance and Farxiga, two SGLT2 inhibitors:
Important Note – SGLT2 inhibitors are not for treating diabetic ketoacidosis or for treating people with type 1 diabetes.
Jardiance
Jardiance (empagliflozin) is a sodium glucose co-transporter 2 (SGLT2) inhibitor that is prescribed to lower blood sugar in persons with type 2 diabetes.
It was approved by the US FDA in 2014.
Manufacturer: Boehringer Ingelheim Pharmaceuticals, Inc.
Farxiga
Farxiga (dapagliflozin) is a first-in-class selective inhibitor of human sodium-glucose co-transporter 2 (SGLT2) and is prescribed to improve glycaemic control in adult patients with type 2 diabetes.
Manufacturer: AstraZeneca and Bristol-Myers Squibb.
Mechanism of Action
Jardiance works by increasing glucose excretion in urine, blocking the reabsorption of glucose by the kidneys, and lowering blood glucose levels in people with diabetes.
Farxiga works by inhibiting SGLT2 activity, therefore modulating reabsorption of glucose in the kidney, leading to excretion of glucose in the urine.
Side Effects
Possible side effects of Jardiance:
- flu-like symptoms;
- increased thirst;
- confusion;
- foul-smelling discharge from the penis;
- swelling of the face, lips, tongue, or throat;
- frequent urination;
- hives;
- burning urination;
- skin rash;
- nausea;
- pain on the skin around the penis;
- rash on the penis;
- vaginal itching;
- yellowish vaginal discharge;
- pelvic pain;
- urine that looks cloudy.
Possible side effects of Farxiga:
- stuffy nose;
- little or no urination;
- signs of a genital infection;
- trouble breathing;
- sore throat;
- unusual drowsiness;
- urinating more than usual;
- confusion;
- stomach pain;
- pain in your pelvis or back;
- vomiting;
- blood in your urine;
- nausea;
- increased urination;
- weakness;
- pain or burning when you urinate;
- dizziness.
Dosage
Jardiance is taken by mouth in either a 10 mg dose or a 25 mg dose.
The recommended dose for Farxiga is 5 mg every morning.
Warnings & Precautions
Jardiance
This medication is not for people with diabetic ketoacidosis (increased ketones in the blood or urine) or for people with type 1 diabetes.
Adults with type 2 diabetes should not take a sodium glucose co-transporter 2 (SGLT2) inhibitor if:
- they are allergic to any ingredient in the medication;
- they are on dialysis;
- they have severe kidney problems.
Farxiga
It is not suitable for people who:
- take Actos (pioglitazone) or loop diuretics;
- are under the age of 18 or over the age of 75;
- have low sodium levels in their body;
- are galactose intolerant;
- have type 1 diabetes;
- have low kidney function.
Drug Interactions
Jardiance may interact in a negative way with the following medications:
- amlodipine;
- losartan (a medication mainly used to treat high blood pressure);
- glimepiride;
- lisinopril;
- glipizide;
- Lantus (insulin glargine);
- insulin.
Farxiga may interact in a negative way with the following medications:
- lisinopril;
- amlodipine (a medication used to treat coronary artery disease and high blood pressure);
- simvastatin;
- carvedilol;
- losartan;
- glimepiride (an orally medium-to-long-acting sulfonylurea antidiabetic drug);
- levothyroxine;
- glipizide;
- hydrochlorothiazide;
- insulin.
Alcohol
Drinking alcoholic beverages can increase your risk of hypoglycemia and lower your blood sugar control if you take drugs for diabetes.
Avoid or limit your use of alcohol while taking these sodium glucose co-transporter 2 (SGLT2) inhibitors.
Is It Safe During Pregnancy or Breastfeeding?
It’s not known whether these sodium glucose co-transporter 2 (SGLT2) inhibitors can harm a breastfeeding baby or if they might cause harm to an unborn baby.
Talk to your doctor before using these medications if you’re pregnant or breastfeeding.
Final Words – Jardiance vs Farxiga
Jardiance (empagliflozin) is an oral diabetes medicine which helps control blood sugar levels.
Empagliflozin is an SGLT2 inhibitor, a drug class that works by stopping sodium-glucose transport proteins which have been filtered out of the blood by the kidneys being reabsorbed back into the blood.
Forxiga (dapagliflozin) is a medication that helps to reduce blood glucose levels by helping the kidneys to remove glucose from the blood.
Dapagliflozin belongs to the class of drugs known as oral antihyperglycemic agents.
According to the latest data presented by Dr. Mikhail Kosiborod at the American College of Cardiology scientific meeting in Washington, SGLT-2 inhibitors (Farxiga, Jardiance, Invokana) substantially reduce the risk of death and hospitalization due to heart failure compared with other medicines for type 2 diabetes.
However, there is evidence which suggests that SGLT2 inhibitors might be related to the development of diabetic ketoacidosis in some suferrers. Taking SGLT2 inhibitors with sulphonylureas, insulin, or glinides may increase the risk of hypoglycemia.
Moreover, SGLT2 inhibitors may raise the risk of urinary tract infections and female yeast infections.
Alternatives to Farxiga & Jardiance
Brand and generic names of SGLT2 inhibitors and combination products that contain SGLT2 inhibitors include:
- Steglatro (ertugliflozin);
- Invokamet XR (canagliflozin and metformin extended-release);
- Invokamet (canagliflozin and metformin);
- Synjardy XR (empagliflozin and metformin hydrochloride);
- Synjardy (empagliflozin and metformin hydrochloride);
- Invokana (canagliflozin);
- Glyxambi (empagliflozin and linagliptin);
- Qtern (dapagliflozin and saxagliptin);
- Xigduo XR (dapagliflozin and metformin extended-release).
Sources https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732143/ https://www.nejm.org/doi/full/10.1056/NEJMoa1504720 https://www.ajmc.com/journals/evidence-based-diabetes-management https://www.boehringer-ingelheim.com/press-release/jardiance-only-diabetes-medication