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Mrs. Wang, 72 years old, has been suffering from diabetes for 20 years.
Although she takes regular insulin injections before each meal and antidiabetic drugs during meals, her blood sugar levels are still difficult to control. After an in-depth understanding of the doctor, it was found that Mrs. Wang did not strictly follow the doctor's instructions and changed her high-sugar and high-fat eating habits.
Her penchant for sweets leads to a high amount of sugar at every meal, resulting in consistently high blood sugar levels after meals. Despite the current situation of poor blood sugar control, Mrs. Wang did not pay enough attention to it.
At the time of follow-up, blood glucose was still not up to standard, but kidney function was good.
So, the doctor changed the medication for her, replacing metformin with dapagliflozin. At the same time, the doctor instructed Mrs. Wang and her family to strictly adhere to a low-sugar diet and continuously monitor blood sugar levels to ensure that blood sugar is effectively controlled.
Through the efforts of both doctors and patients, Aunt Wang's blood sugar was effectively controlled.
However, it was this operation of changing the dressing that made Mrs. Wang's family very puzzled, why did the doctor change the medicine to dapagliflozin instead of empagliflozin? Although there is only a difference of one word, it seems that empagliflozin is popular in the world, and the annual sales volume has reached the level of 10 billion.
What is the difference between the two drugs? Don't worry, in this article, we will answer these questions for you from a medical point of view.
1. There are many types of diabetes hypoglycemic drugs, when do you need empagliflozin and dapagliflozin?
Diabetes mellitus is a long-term metabolic disorder, and its treatment often requires a combination of drugs; Among these treatments, oral hypoglycemic drugs are widely favored because of their convenience and significant therapeutic effects.
These drugs can be broadly divided into several categories, including biguanides, sulfonylureas, α-glucosidase inhibitors, insulin sensitizers, etc., each with its own unique mechanism of action and scope of application.
For example, metformin is the most common of biguanides and is considered the drug of choice for the treatment of type 2 diabetes. It is to control blood sugar levels by reducing glucose production in the liver and enhancing the absorption and utilization of glucose by muscles.
Whereas, sulfonylureas, such as gliclazide and glibenclamide, lower blood sugar by promoting the secretion of insulin by β cells of the pancreas. These drugs are indicated for people with type 2 diabetes who have still pancreatic function.
What has attracted much attention is that with the advancement of medical research, newer hypoglycemic drugs such as empagliflozin and dapagliflozin have gradually become an important option for the treatment of diabetes. These two drugs belong to the class of sodium-glucose cotransporter 2 (SGLT2) inhibitors, and their main role is to reduce the reabsorption of glucose by the kidneys by inhibiting the activity of SGLT2 in the kidneys, thereby promoting urinary glucose excretion and lowering blood glucose levels.
In the course of diabetes management, if the patient's blood glucose level does not reach the predetermined control goal despite conventional basic treatment, including dietary modification, regular exercise, and oral hypoglycemic drugs, the medical professional may consider empagliflozin or dapagliflozin as part of the treatment regimen.
These two drugs belong to the class of SGLT2 inhibitors, which help lower blood glucose levels through their unique mechanism of action, especially for patients who have difficulty achieving glycemic control goals through traditional methods.
Before deciding to use these medications, doctors will evaluate the patient's overall health, history of blood sugar control, and any possible drug interactions to ensure the safety and effectiveness of the treatment regimen.
2. In-depth understanding of empagliflozin and dapagliflozin, clear differences, and better choice
In fact, after the above simple understanding, everyone should also have a vague understanding of these two drugs, empagliflozin and dapagliflozin are two important hypoglycemic drugs, which help patients effectively control blood sugar through special mechanisms. For those who cannot tolerate or have contraindications to traditional oral hypoglycemic drugs such as metformin, empagliflozin and dapagliflozin provide effective alternatives.
However, when considering these medications, we must pay attention to their side effects.
Although empagliflozin and dapagliflozin are able to enhance insulin sensitivity and significantly reduce blood glucose levels, their mechanism of action includes inhibition of glucose reabsorption by the kidneys, which may lead to increased glucose concentrations in the urine. High concentrations of glucose in the urine can be a favorable environment for bacterial growth, increasing the likelihood of urinary tract infections.
In patients with renal insufficiency, the use of these drugs also requires special caution.
Impaired renal function may not only exacerbate the side effects of the drug, such as an increased risk of infection, but may also affect the normal metabolism and excretion of the drug. For this reason, doctors evaluate the patient's glomerular filtration rate (GFR) in detail when recommending empagliflozin or dapagliflozin to ensure that potential kidney damage and risk of infection are avoided.
Although empagliflozin and dapagliflozin are the same kind, they have their own characteristics in terms of chemical composition and therapeutic effect, which determines their differences in clinical application.
First, a patient's kidney function is a key consideration when choosing a drug.
Guidelines for the use of empagliflozin and dapagliflozin are based on different thresholds for glomerular filtration rate (GFR). Specifically, when the GFR of the patient is less than 45 ml/min, neither drug is recommended as an option for glucose-lowering therapy. However, dapagliflozin may be considered for patients with heart failure with reduced ejection fraction who have a GFR of more than 30 mL/minute.
Secondly, from the perspective of efficacy, dapagliflozin has a certain renal protective effect on patients with non-renal insufficiency due to its unique chemical structure.
This protective effect is mainly reflected in its ability to effectively reduce blood sugar levels in the kidneys, and long-term hyperglycemia is an important factor leading to kidney damage. Therefore, for those diabetic patients with normal renal function, the use of dapagliflozin can not only effectively control blood sugar, but also protect the kidneys to a certain extent and delay the decline of kidney function.
Moreover, dapagliflozin can also bring a slight antihypertensive effect while lowering blood sugar, which is especially beneficial for diabetic patients with hypertension.
In addition, in the field of prevention and treatment of cardiovascular diseases, dapagliflozin and empagliflozin have shown their unique protective effects. However, there are subtle differences in the specific cardiovascular disease risk reduction effects.
A WIDE-RANGING CLINICAL STUDY CALLED "EMPA-REG OUTCOME" HAS REVEALED THE DUAL EFFICACY OF EMPAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES: IT NOT ONLY EFFECTIVELY MANAGES BLOOD GLUCOSE LEVELS, BUT ALSO SIGNIFICANTLY REDUCES THE INCIDENCE OF CORONARY HEART DISEASE, THEREBY SIGNIFICANTLY REDUCING THE RISK OF CARDIOVASCULAR-RELATED DEATH.
The study, which focused on those with type 2 diabetes who had a proven cardiovascular disease, showed that members of the empagliflozin group had a 38% lower risk of cardiovascular death compared with a control group treated with placebo.
On the other hand, the "DECLARE-TIMI 58" study demonstrated the other side of the effect of dapagliflozin in patients with type 2 diabetes.
The study found that dapagliflozin was effective in reducing the risk of hospitalization due to heart failure, and in a group of patients with higher cardiovascular risk, dapagliflozin was also shown to reduce the risk of cardiovascular death and myocardial infarction.
Together, these two studies highlight the importance of choosing the right medication for cardiovascular health in people with type 2 diabetes, while also pointing out that the most appropriate treatment may need to be selected on a case-by-case basis in different patient populations.
In the case of Aunt Wang mentioned at the beginning, according to her physical state, dapagliflozin is more suitable; However, which question we mentioned at the beginning, why does empagliflozin sell tens of billions of dollars globally, but it is dapagliflozin that is called the "king of medicine" in China?
3. Empagliflozin's global annual sales are 10 billion, why domestic dapagliflozin has become the "king of medicine"
In the global pharmaceutical market, empagliflozin, as a highly effective hypoglycemic drug, has an annual sales volume of up to 10 billion, showing its wide recognition and application in the world. However, in the Chinese market, the performance of dapagliflozin is particularly prominent, and it is known as the "king of medicine". Behind this phenomenon, there is a profound medical principle.
From a medical point of view, although dapagliflozin and empagliflozin are both suitable for type 2 diabetes and are also recommended for the treatment of heart failure, only dapagliflozin is recommended for the treatment of chronic kidney disease.
There are also certain differences in the pharmacokinetics of the two drugs, for example: serum protein binding rate, dapagliflozin 91% is higher than empagliflozin 86.2%; The efficacy clearance half-life of dapagliflozin is 12.9 hours longer than that of empagliflozin (12.4 hours......
However, it is often the price and familiarity that really influence everyone's choice!
In the mainland, due to the difference in propaganda intensity, the public's familiarity with dapagliflozin is better than empagliflozin, which affects the judgment of the people to a certain extent, why do you say so? Actually, it's very simple, it's like "when there is a problem, you always want to find an acquaintance to find a solution" is a truth, compared to an unfamiliar new thing, people are more inclined to something that is already familiar.
What about the price?
In fact, the price of empagliflozin (20~50 yuan per box) is lower than that of dapagliflozin (69-129 yuan/box), however, due to the low price and low familiarity, the probability of empagliflozin being selected has decreased, because patients are often worried about the efficacy of empagliflozin.
There are also those who believe that while the unit price of dapagliflozin may be comparable to that of similar drugs, the long-term cost may be lower. Because the cardiovascular and renal protective effects of dapagliflozin can reduce the additional medical costs incurred by patients due to complications. Therefore, although the initial investment may be higher, the economic benefits of dapagliflozin are more significant in the long run.
It is worth noting that in the field of modern medicine for the treatment of diabetes, empagliflozin and dapagliflozin, as two important drugs, represent a significant advance in medical science and technology, and they have shown excellent results in blood sugar control. The two drugs are equally effective in controlling sugar, but deciding which drug to use is not a simple choice, but a process that requires a comprehensive evaluation by the doctor according to the patient's specific situation.
Your doctor will consider your overall health in detail, including but not limited to past medical conditions, drug allergies, and other complications that may exist. With such a full evaluation, the appropriate drug can be selected to achieve the purpose of lowering blood sugar.
Of course, let's not forget that the effect of the drug requires the patient to follow the doctor's instructions and improve poor eating habits in daily life, such as a low-sugar diet, coarse grains as the staple food, and green vegetables as the main dishes. Combined with consistent exercise, it can play an adjunctive role in lowering blood sugar.
Write at the end:
Based on the above, fully understand the types of diabetes hypoglycemic drugs, and understand the indications of empagliflozin and dapagliflozin. It is crucial to change the medication under the guidance of a doctor and choose the appropriate hypoglycemic dose. At the same time, paying attention to lifestyle changes, improving hyperglycemia, and reducing the incidence of complications can improve the quality of life of diabetic patients.
Bibliography:
1. Li Xuebo, Fan Yanbin, Du Rui, Chen Fengyi. Clinical study of dapagliflozin, empagliflozin and canagliflozin in the prevention of heart failure in patients with heart failure after myocardial infarction[J].Chinese Journal of Clinical Pharmacology,2023,39(22):3204-3208.
2. Xu Xiaoying, Hou Xingyun, Li Yuzhen, Yu Nianxi, Zheng Jiaoyang. Comparison of sodium-glucose-coupled transporter 2 inhibitors marketed in China[J].World Clinical Drugs,2022,43(06):663-670
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