Empagliflozin – the new type 2 diabetes medication available

In February this year, empagliflozin became fully funded for people who meet certain funding criteria. Here’s what you need to know about this potentially life-saving medicine.

As campaigners for better access to medication for people with type 2, Diabetes NZ is delighted that empagliflozin is now accessible to many New Zealanders who need it.

Empagliflozin is available under the brand name JARDIANCE®. It’s also available in combination with metformin (another older diabetes medication), under the brand name JARDIAMET®. If you’re already on metformin, you may be able to take JARDIAMET®, meaning you can take empagliflozin without taking any extra tablets.

WHAT IS EMPAGLIFLOZIN?

Empagliflozin is a type of diabetes medicine called a sodium-glucose co-transporter 2 (SGLT2) inhibitor. Empagliflozin helps lower bloodsugar levels by blocking a protein in your kidneys called SGLT2. This stops your kidneys from putting glucose back into your bloodstream. Instead, the sugar is removed in your urine when you pee. JARDIANCE® can remove up to about 78g of sugar from your body in a day.

One of the exciting things about empagliflozin is that, for some people, it also helps manage the risks associated with cardiovascular (heart and blood vessels) and kidney disease.

JARDIANCE® OR JARDIAMET®?

Only your healthcare professional can advise if either of these medications is right for you. JARDIANCE® is funded for people with type 2 diabetes and established cardiovascular disease to reduce the risk of cardiovascular death. It can be used in combination with other glucose-lowering medication including insulin, when these, together with healthy food and physical activity, do not provide adequate control of blood glucose.

JARDIAMET® is indicated when blood sugar is inadequately controlled with metformin or empagliflozin alone (or in combination with insulin therapy), or if you are already treated with empagliflozin and metformin as separate tablets.

Both JARDIANCE® and JARDIAMET® are also indicated for people who have both type 2 diabetes and established cardiovascular and kidney disease. These people should use these medications in conjunction with other measures to reduce cardiovascular risk.

WHO IS ELIGIBLE FOR FUNDED EMPAGLIFLOZIN?

Having JARDIANCE® or JARDIAMET® funded means you will pay only $5 per prescription. You may be eligible to have one of these medications funded if you have type 2 diabetes and you are at high risk of heart and kidney complications. High-risk groups include people with:

• Māori or any Pacific ethnicity

• pre-existing cardiovascular disease

• a high five-year risk of cardiovascular disease (15% or greater)

• a high lifetime risk of cardiovascular disease from being diagnosed with type 2 diabetes during childhood or as a young adult

• diabetic kidney disease.

You may be eligible if your diabetes has not been well controlled by another blood-sugar-lowering drug that you have taken for at least three months. To measure this, your healthcare provider will use an HbA1c blood test. This tests your average blood sugar over the past approximately three months. You will be eligible if your test result is higher than 53 mmol/mol.

If you qualify, your healthcare provider will apply for a Special Authority for you. The Special Authority number will be on your prescription, so your pharmacy knows the medicine is funded. You will only need to get this Special Authority once.

IS LOW BLOOD SUGAR A RISK WITH THESE MEDICATIONS?

If you’re on another medication to treat type 2 diabetes, your risk of hypos (low blood sugar) may be increased when you take JARDIANCE® or JARDIAMET®.

It’s important to know the signs of low blood sugar. Tell your healthcare provider as soon as possible if you notice sweating, dizziness, flushing or paleness, weakness, trembling, numbness, strong hunger, headache, or a fast pounding heartbeat.

WHAT ABOUT OTHER SIDE EFFECTS?

Other possible side effects with empagliflozin can include weight loss, lower blood pressure, urinary tract infections, and genital thrush. So, tell your doctor or pharmacist if you notice any of these:

• genital burning, redness, pain, and discharge

• passing more urine than normal

• itching

• excessive thirst.

Genital thrush may well be avoided by regular good hygiene. Drinking plenty of water reduces your risk of urinary tract infections.

Rare, serious side effects According to Medsafe, the most serious possible side effects, although they are rare, are diabetic ketoacidosis (DKA) and necrotising fasciitis of the perineum (Fournier’s gangrene).

DKA is caused by a build-up of substances called ketones in the blood. DKA symptoms include rapid weight loss, nausea, abdominal pain, excessive thirst, difficulty breathing, confusion, or unusual fatigue, a sweet smell to your breath, a sweet or metallic taste in your mouth, or a different odour to your urine or sweat.

Fournier’s gangrene symptoms include pain, redness or swelling in the genital or perineal area, fever, or malaise.

If you have any of these symptoms, contact your health provider immediately.

THINGS TO REMEMBER IF YOU’RE ON JARDIANCE® OR JARDIAMET®

• If you miss a dose, and it is less than 12 hours before your next dose, skip the dose you missed and just take your next dose when you’re meant to.

• If you miss a dose, and it is more than 12 hours before your next dose, take your dose as soon as you remember, and then go back to taking your medicine as you would normally.

• Do not ever take a double dose to make up for a dose that you missed. This may increase the chance of an unwanted side effect. If you’re not sure what to do, ask your healthcare provider or pharmacist.

• Before and while taking an empagliflozin medication, make sure you tell your doctor or pharmacist if you’re taking any other medicines, in case these may react in some way. That includes any medicines that you get without a prescription from your pharmacy, supermarket, or health food shop.

• If you have a stomach bug or are unwell in any other way that means you can’t eat normally, consult your health care provider. They may recommend that you temporarily stop taking JARDIANCE® or JARDIAMET® until you can eat normally again.

• The same goes for if you’re preparing for surgery or a procedure and need to fast or eat differently: consult your healthcare provider.

• JARDIANCE® can be taken with or without food, while JARDIAMET®, because of the metformin it contains, needs to be taken with food.

BEYOND THE MEDICATION

It’s important that empagliflozin, like other medications for type 2 diabetes, is seen as just one part of treatment. Staying active and trying to eat well are just as important.