A selective inhibitor of sodium glucose cotransporter 2 for the treatment of type two diabetes.

Trade name Jardiance.

Given as a monotherapy or as an add-on therapy reduces glycated hemoglobin levels in patients with type two diabetes including those with stage 2 or 3a chronic kidney disease.

In a wide range of patients with chronic kidney disease empagliflozin therapy, lead to lower risk of progression of kidney disease, or death from cardiovascular causes than placebo.

Associated with weight loss and reductions in blood pressure without increases in heart rate.

Has favorable effects on markers of arterial stiffness and vascular resistance, visceral adiposity, albuminuria, and plasma urate.

Associated with increased levels of both low density lipoprotein and high density lipoprotein cholesterol.

Most common side effects are urinary tract infections and genital infections, though patients may also experience dehydration and hypotension among others.

It’s use in patients with type two diabetes is associated with a lower rate of primary composite cardiovascular outcome and of death from any cause when added to standard care (EMPA-REG OUTCOME Investigators).

Empagliflozin has a cardiovascular mortality benefit.

Empagliflozin showed a significant reduction in the development of worsening kidney function, defined as the composite of doubling of the serum creatinine level, an increase in albuminuria, initiation of renal replacement therapy, or death due to kidney disease.

Empagliflozin Cardiovascular Outcome Event Trial indicated reduced risk of cardiovascular death, nonfatal myocardial infarction or nonfatal stroke relative to those who received placebo.

Empagliflozin in the above trial reduced hospitalization for heart failure.

Among SGLT agents empagliflozin, associated with a reduction in cardiovascular mortality.

Canaglifozin associated with a relatively increased risk for amputations.

New indication by the US Food and Drug Administration for reducing risk of cardiovascular death in adult patients with type 2 diabetes and cardiovascular disease.

Death from cardiovascular disease is more than 70% higher among adults with diabetes compared with the general population and the reduced life expectancy of patients with diabetes is driven largely by premature cardiovascular death.

Not intended for patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.

Contraindicated in patients severe renal impairment, end-stage renal disease, or dialysis.

It slows deterioration in renal function and reduce his hospitalizations for heart failure and cardiovascular mortality.

Its use among patients with heart failure had a lower risk of cardiovascular death or hospitalization than in the placebo group, regardless of the presence or absence of diabetes. (Packer M).

Among patients at increased risk for heart failure after acute myocardial infarction treatment with empagliflozin did not lead to a significant lower risk of first hospitalization for heart failure, or death from any cause than placebo.

E reduces the combined risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and preserved ejection fraction, regardless of the presence or absence of diabetes.
In patients with diabetes the risk of hospitalization for heart failure is 30-35% lower among patients who receive SGLT2 inhibitors than among those who receive placebo, and the benefit is most striking in patients who have a left ventricular ejection fraction of 30% or less before treatment.
The risk of progression of renal disease including the need for dialysis or a renal  transplantation is 35-50% lower among patients to receive SGLT 2 inhibitors than among those who receive placebo.
SGLT 2 inhibitors slow the progression of cardiac and renal disease regardless of the cause an independent of the presence or absence of diabetes.

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