HARTFORD – Almost 30 million Americans have diabetes, which is a major cause of blindness, kidney disease, and heart disease in the United States.
The FDA stated earlier this month that a newer drug for type-2 diabetes called Jardiance could do more than just help reduce blood sugars. It could also reduce the risk of cardiovascular events.
Type-1 diabetes is caused by the destruction of the Islets of Langerhans, cells in the pancreas who make insulin. For type-1 diabetics, they need to receive insulin therapy to prevent diabetic ketoacidosis and this FDA ruling does nothing for their treatment. In type-2 diabetes, your pancreas can still make some insulin but not enough to meet the needs of the body. There are a host of drugs that can be given to reduce their blood sugars including insulin and that is the population impacted by this ruling.
Until recently, type-2 diabetes trials focused on whether or not people’s blood sugars and Hemoglobin A1c concentrations were reduced, not whether they were good for the heart and brain. It was expected that since diabetes predisposes to cardiovascular disease that reducing blood sugars also reduces these risks. Metformin was found to provide these benefits but the sulfonylureas like glyburide and glipizide actually increase cardiovascular events, even as they reduced blood sugars. Then a drug from the “glitazone” class called rosiglitazone increased the risk of heart failure. This led to metformin becoming the undisputed first line therapy for type-2 diabetes but whether other drugs could improve cardiovascular disease risk was not known. The EMPA-REG Outcome trial was a multicenter, randomized, double-blind trial, the best kind of trial that there is.
Over 7,000 people with diabetes and cardiovascular disease who were treated with other drugs for diabetes had Jardiance or placebo added to the regimen and were followed for 3 years. They found that cardiovascular death or nonfatal heart attacks and strokes were reduced by 14 percent in those receiving Jardiance. Since ¾ of patients received metformin, there is high confidence that adding Jardiance to metformin will give extra reductions in cardiovascular events.
Even if a drug doesn’t reduce cardiovascular events, it can still reduce the risk of blindness, kidney disease, and severe hyperglycemia ,which is bad in its own right. So it is critical not to stop your diabetes drugs without talking with your doctor first but at your next appointment, this can be something to discuss.
Metformin is still the first line therapy for most patients and Jardiance could be a great supplemental drug if you still need additional glucose control. One difference between Jardiance and the sulfonylureas is that Jardiance is associated with some weight loss and sulfonylureas increase body weight. Weight loss is always an important part of reducing cardiovascular disease and this drug helps with that by putting more excess glucose out in the urine.
Dr. Michael White of the UConn School of Pharmacy