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Nov 23, 2023


Choosing Wisely: Metformin vs. Jardiance for Type 2 Diabetes

Type 2 Diabetes

Type 2 diabetes is a common health issue where your body doesn't use insulin properly. Insulin is a hormone made by your pancreas that helps turn sugar (glucose) from the food you eat into energy.

Normally, insulin helps your cells absorb glucose, keeping your blood sugar levels in check. In type 2 diabetes, however, your cells don't respond well to insulin, a problem known as insulin resistance. When this happens, your pancreas tries to make more insulin to get your cells to respond.

Initially, this extra insulin keeps your blood sugar normal. But over time, your pancreas can't keep up, and your blood sugar rises, leading to prediabetes and eventually type 2 diabetes if not managed well.

High blood sugar can cause serious health problems, like heart disease, stroke, and kidney failure. That's why it's crucial to take type 2 diabetes seriously. Managing it with healthy lifestyle changes and medication can prevent these complications, improve your life quality, and lower the risk of life-threatening issues.


Metformin is a widely used prescription medicine for type 2 diabetes. It belongs to a group of drugs known as Biguanides and is often the first medication recommended for managing diabetes.

To get the best results, it's advised to pair Metformin with a healthy diet and regular exercise.

How Metformin Works

DPP-4 inhibitors work by inhibiting the DPP-4 enzyme, which breaks down key hormones like GLP-1 and GIP. By preserving the levels of these hormones, these medications help in enhancing the body's natural ability to regulate blood sugar levels.

The drug works in two main ways: it lowers the amount of sugar your liver makes and reduces the sugar absorbed by your intestines. This double action helps keep your blood sugar levels more stable.

Your liver plays a key role in regulating blood sugar by producing glucose, especially when you haven't eaten. In type 2 diabetes, your liver can produce too much glucose. Metformin helps by slowing down this process, lowering your liver's contribution to high blood sugar levels.

Besides these effects, Metformin can also influence hormones in the gut and may lead to modest weight loss. This makes it especially beneficial for people with type 2 diabetes who are also dealing with weight issues.

Availability of Metformin

Metformin is available in tablet form, with dosages of 500, 850, and 1,000 mg. It's taken orally and is best consumed with food to minimize stomach upset.

You might start seeing a decrease in your blood sugar levels within the first week of taking Metformin, but it could take 2 to 3 months to experience its full effects.

There are two types of Metformin tablets: immediate-release (IR) and extended-release (ER). The immediate-release tablets are usually taken once or twice a day with meals, while the extended-release tablets are taken once daily with your evening meal.

Metformin is available both as a brand-name and a generic medication. The generic version is more affordable, making Metformin a cost-effective choice.

Effectiveness of of Metformin

The effectiveness of Metformin has been confirmed in various clinical studies, including one that found Metformin significantly reduced the risk of diabetes-related complications and mortality, especially in overweight individuals with type 2 diabetes.

Typically prescribed as a first-line treatment, Metformin shows improved efficacy when combined with lifestyle changes. It's also associated with modest weight loss in some patients, although individual responses can vary.

Side Effects

Common side effects:

  • Low blood sugar
  • Upset stomach, gas, nausea, or diarrhea
  • Indigestion
  • Weakness
  • Headache
  • Low vitamin B12 levels
  • Changes in your taste

Serious side effects:

  • Lactic acidosis, which is described as having too much lactic acid in your blood that may lead to death. Call your doctor or get emergency medical help if you have unusual muscle pain, feeling cold, fast or difficulty breathing, shortness of breath, or feeling weak, dizzy, or lightheaded.
  • Low vitamin B12 levels, which could cause symptoms such as low energy, muscle weakness, decreased appetite, or tingling or numbness in your hands and feet.
  • Hypoglycemia, also known as low blood sugar, which could cause symptoms such as feeling nervous, anxious, or irritable, having a fast heartbeat, sweating or body chills, confusion, feeling sleepy, weakness, or increased hunger.

If you’re experiencing any of these serious side effects, immediately call your doctor and stop taking this medication.

If Metformin isn’t effective alone or if you’re managing Type 2 diabetes alongside other health conditions, your doctor may opt to add to your treatment with an additional medication. Jardiance may stand out as a potential choice in such cases.


Jardiance, known as Empagliflozin, is a prescription drug categorized as a sodium-glucose co-transporter 2 (SGLT2) inhibitor. Currently, Jardiance is only available under its brand name; generic versions are not expected to be on the market until at least 2025.

How Jardiance Works

Jardiance targets SGLT2, a protein in your kidneys that reabsorbs glucose back into your bloodstream. By inhibiting this protein, Jardiance prevents glucose reabsorption, leading to the removal of excess glucose through urine, thus reducing blood sugar levels in people with type 2 diabetes.

Beyond managing blood sugar, Jardiance has shown benefits for heart and kidney health. It can lower the risk of severe complications, hospitalization, and death in adults with heart failure or chronic kidney disease (CKD).

Research indicates that Jardiance can also reduce cardiovascular events and decrease hospitalizations for heart failure in those with type 2 diabetes and either existing cardiovascular disease or multiple cardiovascular risk factors.

Jardiance's ability to inhibit sodium reabsorption can improve heart function by making it easier for the heart to pump blood. This effect also benefits the kidneys, improving blood flow to them, which can reduce stress on these organs and potentially slow the progression of CKD.

Availability of Jardiance

Jardiance is available in tablet form, with doses of 10 mg and 25 mg. It can be taken orally, with or without food.

The usual starting dose is 10 mg, taken orally once a day in the morning. Your doctor may increase the dose to 25 mg daily, depending on how well the medication controls your condition. It typically starts working within 30 to 60 minutes, but it may take a few days to several weeks to significantly impact blood sugar levels. Your doctor will monitor your progress and adjust the dosage if necessary.

Effectiveness of Jardiance

Approved by the FDA in 2014 for type 2 diabetes, Jardiance is a relatively new medication. It's been effective in lowering A1C levels by up to 1%.

A notable aspect of Jardiance is its proven benefits for patients with heart disease, making it the first in its class to demonstrate such effectiveness. Additionally, it has shown potential in slowing the progression of chronic kidney disease (CKD) in certain cases.

Clinical trials have also reported weight loss in individuals with type 2 diabetes taking Jardiance. On average, participants saw about a 3% reduction in their initial body weight over about 6 months. It's important to note, though, that Jardiance is not specifically FDA-approved for weight loss, and any weight loss experienced may be a secondary effect of treatment.

Side Effects

Common side effects:

  • Urinary tract infections or UTIs
  • Upper respiratory tract infection
  • Genital yeast infection
  • Joint pain
  • Increased urination
  • Increased thirst
  • Increased cholesterol levels

Serious side effects:

  • Dehydration
  • Ketoacidosis, which is also described as a serious condition where your body produces high levels of blood acids called ketones
  • Hypotension or low blood pressure
  • Acute kidney injury
  • Serious urinary tract infections
  • Fournier's gangrene, which is described as a rare but serious bacterial infection of your genital and perineal area

If you’re experiencing any of these serious side effects, immediately call your doctor and stop taking this medication.

Choosing Between Metformin and Jardiance for Type 2 Diabetes

Metformin and Jardiance are both effective for managing type 2 diabetes, but they have different uses and side effects.

  • Metformin: Often the first choice for diabetes treatment. It's known for being effective and affordable, but some people might experience side effects.
  • Jardiance: Useful for those with heart or kidney issues along with diabetes. It's a newer option and can be more expensive.

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Your doctor might suggest using both together, especially if Metformin alone isn't enough. It's important to discuss with your healthcare provider to find the best treatment for your specific needs. Remember, the right medication can vary for each person.

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