Jardiance, with the active ingredient empagliflozin, is a medication prescribed for adults with type 2 diabetes. It is also used to reduce the risk of cardiovascular death in adults with both type 2 diabetes and established heart disease, and to manage certain types of heart failure and chronic kidney disease. The drug improves glycemic control as an adjunct to diet and exercise. Jardiance operates through a distinct biological process within the kidneys to exert its effects on blood sugar and provide its additional health benefits.
The Role of SGLT2 Proteins in the Kidneys
Within the filtering system of the kidneys, sodium-glucose co-transporter 2 (SGLT2) proteins play a part in conserving the body’s resources. These proteins are primarily located in the proximal tubules of the kidneys. These tubules are responsible for reclaiming water and solutes from the fluid that has been filtered out of the blood. The main function of SGLT2 proteins is to reabsorb glucose from this filtered fluid and return it to the bloodstream.
This reabsorption process is a normal mechanism designed to prevent the loss of glucose in the urine. In a person without diabetes, the kidneys filter a significant amount of glucose daily, and SGLT2 is responsible for reabsorbing about 90% of it. In individuals with type 2 diabetes, where blood glucose levels are elevated, these transporters can contribute to maintaining high blood sugar by continuing to reabsorb glucose.
How Jardiance Targets SGLT2
Jardiance is an SGLT2 inhibitor, and its mechanism involves blocking these proteins. The drug’s active molecule, empagliflozin, selectively binds to the SGLT2 proteins. This action obstructs the transporters, preventing them from shuttling glucose from the filtered fluid back into circulation.
By inhibiting SGLT2 proteins, Jardiance alters the kidney’s handling of glucose. Its effect is independent of the body’s sensitivity to insulin or insulin production. This targeted action ensures that more glucose remains in the filtrate that will eventually become urine.
The inhibition of SGLT2 is a dose-dependent process. A 10 mg dose of empagliflozin leads to the excretion of approximately 64 grams of glucose per day. Increasing the dose to 25 mg can increase the daily urinary glucose excretion to around 78 grams.
Lowering Blood Sugar Through Urine
The primary therapeutic outcome of Jardiance’s action is the reduction of blood glucose levels. Because the SGLT2 transporters are blocked, they are unable to reabsorb their usual amount of glucose from the fluid filtered by the kidneys. This leads to a lower renal threshold for glucose, which is the point at which glucose begins to appear in the urine.
Consequently, the excess glucose that is not reabsorbed is eliminated from the body through urination. This increased excretion of glucose directly translates to lower concentrations of sugar in the bloodstream. For individuals with type 2 diabetes, this process helps improve glycemic control.
Additional Health Effects of Jardiance’s Mechanism
The impact of Jardiance’s mechanism extends beyond lowering blood sugar. The excretion of glucose in the urine means the body is also losing calories, which can contribute to a modest amount of weight loss for some individuals.
The SGLT2 inhibition process also has an effect on fluid and sodium balance. By blocking the reabsorption of sodium along with glucose, Jardiance promotes the excretion of both in the urine. This has a mild diuretic effect, leading to a reduction in the body’s total volume of fluid and a subsequent decrease in blood pressure.
The drug provides significant cardiovascular and kidney protection. These protective effects are linked to a combination of factors stemming from SGLT2 inhibition, including improved heart and kidney hemodynamics, reduced sodium load, and changes in metabolism. These broader physiological impacts are why Jardiance is prescribed for reducing risks in patients with heart failure and chronic kidney disease.