Jardiance (empagliflozin) is widely considered one of the more effective type 2 diabetes medications available, largely because it does more than lower blood sugar. In major clinical trials, it reduced the risk of cardiovascular death by 38% and heart failure hospitalizations by 35% compared to placebo. These benefits, combined with modest weight loss and blood pressure improvements, have made it a preferred option in current treatment guidelines, particularly for people with heart disease or kidney problems alongside diabetes.
How Jardiance Works
Your kidneys normally reabsorb about 97% of glucose filtered from the blood. Jardiance blocks a transporter in the kidneys responsible for that reabsorption, causing excess glucose to leave the body through urine instead of cycling back into the bloodstream. This mechanism also pulls extra sodium and water along with it, which is why the drug lowers blood pressure and produces a mild diuretic effect.
Because the drug works through the kidneys rather than by increasing insulin, it carries a low risk of causing dangerously low blood sugar on its own. The calorie loss from excreting glucose also creates a persistent negative calorie balance, which contributes to gradual weight loss over time.
Blood Sugar and Weight Reduction
In clinical trials reviewed by the FDA, Jardiance lowered HbA1c (a three-month average of blood sugar) by about 0.84 percentage points more than placebo. That’s a meaningful drop, roughly equivalent to what many other diabetes medications achieve. For someone with an A1c of 8.5%, for example, that could bring them closer to the 7% target most guidelines recommend.
Most people also lose some weight. The exact amount varies, but the combination of excreting glucose (and its calories) plus mild fluid loss typically produces a noticeable change in the first few months. Blood pressure tends to drop as well. One study found systolic blood pressure decreased by about 5 mmHg on average, with an even larger drop of 6 mmHg during nighttime, which may help improve the natural blood pressure rhythm that’s often disrupted in people with diabetes.
Heart and Kidney Protection
This is where Jardiance separates itself from many older diabetes drugs. The landmark EMPA-REG OUTCOME trial enrolled people with type 2 diabetes who already had cardiovascular disease and found that adding Jardiance to standard care reduced cardiovascular death by 38% and hospitalizations for heart failure by 35%. These results were striking enough to reshape how doctors think about diabetes treatment: blood sugar control matters, but so does choosing a medication that independently protects the heart.
The kidney data is similarly strong. In the EMPA-KIDNEY trial, Jardiance cut the rate of long-term kidney function decline roughly in half, slowing the annual loss from 2.75 to 1.37 units of kidney filtration capacity per year. This benefit extended even to people with very little protein in their urine, a group previously thought less likely to benefit. For someone with chronic kidney disease, that kind of slowing can mean years of difference before dialysis becomes necessary.
Current American Diabetes Association guidelines specifically recommend Jardiance (and other drugs in its class) for people with type 2 diabetes who also have heart failure, whether the heart’s pumping ability is reduced or preserved. The recommendation is based on proven improvements in symptoms, physical function, and quality of life.
Common Side Effects
Because Jardiance increases glucose in the urine, it creates a friendlier environment for yeast and bacteria. In pooled clinical trials, genital yeast infections occurred in about 5% to 6% of women taking Jardiance compared to 1.5% on placebo. For men, the rate was roughly 2% to 3% versus 0.4% on placebo. These infections are typically mild and treatable, but they can be recurrent for some people.
Urinary tract infections showed a smaller increase, affecting about 9.3% of people on the 10 mg dose compared to 7.6% on placebo. The difference was more pronounced in women, where rates reached 17% to 18% regardless of dose. Increased urination and mild dehydration are also common, especially in the first few weeks, since the drug acts as a gentle diuretic.
A Rare but Serious Risk
The most concerning potential side effect is a condition called euglycemic ketoacidosis, where the body builds up dangerous levels of acid even though blood sugar appears normal or only slightly elevated. This is rare, but it’s deceptive because the normal blood sugar reading can delay diagnosis. Symptoms include nausea, vomiting, abdominal pain, excessive thirst, shortness of breath, and confusion.
The risk increases significantly when other stressors are present: acute illness, infection, surgery, severe dehydration, heavy alcohol use, very low carbohydrate diets, or reductions in insulin dose. If you’re scheduled for surgery, your doctor will likely have you stop Jardiance several days beforehand. The key takeaway is to pay attention to how you feel, not just your glucose readings, especially during illness.
Who Shouldn’t Take It
Jardiance depends on kidney function to work. It shouldn’t be started if your eGFR (a measure of how well your kidneys filter) is below 45, and it’s fully contraindicated below 30 or in people on dialysis. If your kidney function drops below 45 while you’re already taking it, the medication should be stopped. No dose adjustment is needed above that threshold.
People with type 1 diabetes should not take Jardiance, as the risk of ketoacidosis is substantially higher in that population. It’s also not appropriate for anyone with a history of serious hypersensitivity reactions to empagliflozin.
Cost and Access
The list price for a month’s supply of Jardiance is $350, which puts it well above older generic diabetes medications like metformin. However, the manufacturer offers a savings card through its CareConnect4Me program that can reduce the cost to as little as $0 for a 30- to 90-day prescription for eligible patients. Insurance coverage varies widely, and some plans require trying cheaper alternatives first.
No generic version of Jardiance is currently available in the United States, which keeps the out-of-pocket cost high for uninsured or underinsured patients. For people whose primary need is blood sugar reduction alone, less expensive options may work just as well. But for those with heart failure, established cardiovascular disease, or chronic kidney disease, the added benefits of Jardiance may justify the higher price, and this is a conversation worth having with your prescriber.