If you watch television, there is a decent chance you have seen a Jardiance commercial. The manufacturer is promoting “Big News” about this diabetes drug. Towards the end of the TV spot, the interviewer asks a patient: “What do you think?” The person responds: “I think it’s time to think about Jardiance.” The tagline: “Ask your doctor about Jardiance and get to the heart of what matters.” What’s this all about?
The Diabetes Dilemma!
Diabetes is a leading cause of death. The CDC states (July 18, 2017) that:
“More than 100 million U.S. adults are now living with diabetes or prediabetes according to a new report released today by the Centers for Disease Control and Prevention (CDC). The report finds that as of 2015, 30.3 million Americans – 9.4 percent of the U.S. population – have diabetes. Another 84.1 million have prediabetes, a condition that if not treated often leads to type 2 diabetes within five years.”
Complications of type 2 diabetes include kidney disease, eye and nerve damage, dementia and cardiovascular problems such as heart disease and strokes. The goal of treating diabetes is to reduce the likelihood of developing these serious health problems.
What About the PreDiabetes Dilemma?
It used to be that health care professionals didn’t get nervous about elevated blood glucose levels until they repeatedly exceeded 140 mg/dL after eating. More specifically, a level over 200 mg/dL was considered a red flag or a hemoglobin (Hb) A1c greater than 6.5 or 7. These day, though, many physicians diagnose diabetes when fasting blood glucose levels exceed 126 mg/dL.
Prediabetes is diagnosed when blood sugar levels are repeatedly between 100-125 mg/dL. That’s in a fasting state. When HbA1c levels reach 5.7% to 6.4% many doctors will diagnose prediabetes.
This reader is confused about prediabetes and a prescription for Jardiance (empagliflozin):
Q. If a person with pre-diabetes takes Jardiance, can it trigger type 2 diabetes? My friend is a cardiac patient who had open-heart surgery a decade ago. His cardiologist says he should take Jardiance. His GP didn’t recommend it. Then he saw an endocrinologist who said if he didn’t take the Jardiance he’d end up on daily injections. Mind you, he didn’t have a diabetes diagnosis.
He is a vibrant man, slightly overweight and sexually active. He took his first dose last night, and today he tested his blood sugar. The meter said he is diabetic, and we are both freaking out. How could he go from pre-diabetes to diabetes overnight?
A. The boundary between pre-diabetes and diabetes may be more of a gray zone than a bright line. After all, blood sugar changes throughout the day depending on what you have eaten and when as well as how much physical activity you are getting. The endocrinologist seems to have imagined that your friend was likely to develop diabetes.
Cardiologists are enthusiastic about Jardiance (empagliflozin) for people with heart failure. However, a recent trial did not show any benefit for those who had heart attacks (New England Journal of Medicine, April 25, 2024).
We have found no reports that Jardiance can speed the transition from prediabetes to diabetes. On the other hand, we can’t find any randomized controlled trials showing that it prevents this progression, either. You can read more about the pros and cons of Jardiance in our eGuide to Preventing & Treating Diabetes. This online resource may be found under the Health eGuides tab.
A Surprising Diabetes Drug Problem:
One of the unexpected consequences of some diabetes medicines was an increased risk of heart attacks, heart failure and other cardiovascular complications. No doubt this came as a big shock to the companies as well as the Food and Drug Administration.
You can learn more about some of these unanticipated complications at this link:
Diabetes Drugs: A Disappointing Tale of Broken Promises
The FDA then required companies to test newer diabetes drugs for the potential to cause heart problems.
Certain companies breathed a sigh of relief when their diabetes medications didn’t cause heart attacks and strokes. But they didn’t mention that these drugs also failed to prevent such catastrophes.
The Jardiance “Big News” Commercial:
That’s why the maker of empagliflozin (Jardiance) has been bragging about the performance of its diabetes medicine. The television commercial in question features a man announcing:
“Today we’re out here with some big news. Jardiance is the only type 2 diabetes pill proven to both significantly reduce the chance of dying from a cardiovascular event in adults who have type 2 diabetes and heart disease AND lower your [Hb]A1c.”
The patient in the commercial responds with just one word:
“Wow!”
A female voice then rapidly reads a list of possible adverse reactions:
“Jardiance can cause serious side effects including dehydration. This may cause you to feel dizzy, faint or lightheaded or weak upon standing.
“Ketoacidosis is a serious side effect that may be fatal. Symptoms include nausea, vomiting, stomach pain, tiredness and trouble breathing. Stop taking Jardiance and call your doctor right away if you have symptoms of ketoacidosis or an allergic reaction. Symptoms of an allergic reaction include rash, swelling and difficulty breathing or swallowing.
“Do not take Jardiance if you are on dialysis or have severe kidney problems. Other side effects are sudden kidney problems, genital yeast infections, increased bad cholesterol and urinary tract infections, which may be serious.”
Fast Forward to 2023 Jardiance Commercials:
The latest commercials have people singing and dancing. You really need to watch people stating that:
“It’s a little pill with a big story to tell”
Then you can watch the postman dancing with the overweight star of the show while the announcer states:
“Jardiance can lower the risk of cardiovascular death too.”
Now, it’s not the only diabetes drug that has cardiovascular benefits. The newer commercials are enthusiastic but they can no longer brag about being the only diabetes medicines that can be helpful for the heart.
Jardiance Side Effects: Reports from Real People
The long list of side effects in the commercial may sound abstract, especially when you hear them spoken rapidly while watching people having fun. But for some of our readers they are anything but.
One person wrote:
“Jardiance landed me in the hospital with diabetic ketoacidosis (DKA). It’s potentially fatal. The medical staff suspected that this med was the culprit, and in fact admitted that they had had a case similar to mine just a few weeks prior.”
Another reader had a different experience with Jardiance:
“I recently was hospitalized for a week with severe blood sepsis. The sudden appearance of a kidney stone stopped the flow of urine. I believe it was caused by the drug Jardiance. This drug can cause dehydration and ‘sudden acute kidney injury.’ The elderly are at highest risk.
“I reported this problem to the FDA, but the reporting process is time-consuming. You also have to be very computer savvy. I believe others might be suffering unreported reactions.”
This reader reports a side effect that was hard to track down:
Q. I have a friend who came in contact with Agent Orange while serving in Vietnam. As a result, he now has diabetes. At 73, he is active working as a handyman. His doctor put him on Jardiance about four months ago. He is complaining about muscle and joint aches and thinks that Jardiance is causing his pain. Could it be?
A. Jardiance helps control blood sugar and reduces the risk of cardiovascular events like heart attacks. According to the prescribing information, nearly as many people on placebo had joint pain as those on Jardiance. Muscle pain is not listed as an adverse reaction.
On the other hand, doctors in Australia have described the case of a 69-year-old man who developed muscle pain, weakness and wasting while on empagliflozin (Endocrinology, Diabetes & Metabolism Case Reports, April 12, 2020). His symptoms disappeared within weeks of stopping the drug, and the doctors could find no other explanation. Although it appears to be rare, this type of reaction is possible.
Your friend can learn about other types of diabetes drugs to discuss with his doctor in our eGuide to Preventing & Treating Diabetes. This online resource is available under the Health eGuides tab.
The People’s Pharmacy Perspective:
Doctors need to alert patients to the potential risks as well as the benefits of diabetes drugs. Lowering blood sugar is important, but the ultimate goal is avoiding complications from both prescribed medications and type 2 diabetes.
Learn more about some other ways to help manage blood sugar in our Guide to Managing Diabetes at this link.
