Forxiga and Jardiance

How do they work and why they changed diabetes treatment

In modern practice, few drug classes have produced such a profound shift as SGLT2 inhibitors. Two of the most widely used are Forxiga and Jardiance—agents that have moved well beyond their original role as “glucose-lowering drugs” and are now considered true cardio-renal therapies.

If diabetes care once focused almost exclusively on lowering blood glucose, today the goals are broader: preventing complications, protecting organs, and improving survival. This is exactly where these medications stand out.

How the kidney contributes to glucose control

To understand the mechanism, we start with physiology.

Every day, the kidneys filter around 180 liters of blood. Along with this filtration, a significant amount of glucose enters the primary urine. Under normal conditions, nearly 100% of this glucose is reabsorbed back into the bloodstream through the SGLT2 transporter.

This is an energy-conserving mechanism. The problem arises in diabetes, where the body continues—and even intensifies—this reabsorption despite already elevated glucose levels.

Foreigner In Romania and in need of a prescription for your chronic treatment?

Contact Dr. Petrache’s Virtual Clinic for any medical issue you encounter while in Romania. Send an email to: clinica@diabet-si-nutritie.ro

Mechanism of action – a completely different approach

Forxiga and Jardiance inhibit the SGLT2 transporter in the kidneys.

What happens next:

• glucose is no longer reabsorbed
• it is excreted in the urine (glycosuria)
• blood glucose levels decrease independently of insulin

This mechanism is unique because it does not rely on pancreatic function or insulin sensitivity.

In simple terms, the body gets rid of excess sugar through a controlled, physiological pathway.

How much glucose is lost daily?

Depending on blood glucose levels, approximately 60–80 grams of glucose can be excreted per day.

This translates into:

• 240–320 kcal lost daily
• a steady, mild caloric deficit

This detail explains part of the metabolic benefits observed in patients.

Effects on blood glucose

These medications:

• lower fasting glucose
• reduce postprandial glucose
• decrease HbA1c

A key advantage:

• low risk of hypoglycemia when used alone (without insulin or sulfonylureas)

For many patients, this means greater day-to-day safety.

Effects on body weight

Due to continuous glucose loss:

• average weight loss of 2–4 kg
• reduction in visceral fat
• improvement in metabolic profile

Importantly, this effect tends to be sustained over time.

Effects on blood pressure

These drugs also induce osmotic diuresis:

• increased sodium and water excretion
• reduced circulating volume

The result:

• mild blood pressure reduction
• decreased cardiac workload

This is particularly beneficial in hypertensive patients.

Tourist in Romania and in need of a prescription for your chronic treatment?

Contact Dr. Petrache’s Virtual Clinic for any medical issue you encounter while in Romania. Send an email to: clinica@diabet-si-nutritie.ro

Cardiovascular benefits – beyond glucose control

Both Jardiance and Forxiga have been extensively studied in major clinical trials.

Findings include:

• reduced risk of hospitalization for heart failure
• reduced cardiovascular mortality (more evident with Jardiance)
• benefits that can appear within months

These effects go beyond glucose lowering and likely involve:

• reduced oxidative stress
• improved cardiac energy metabolism
• favorable hemodynamic changes

Renal protection – a key pillar

Another major benefit is kidney protection.

These medications:

• reduce glomerular hyperfiltration
• lower intraglomerular pressure
• slow progression of chronic kidney disease

Long term:

• reduce the risk of dialysis
• slow decline in renal function

For this reason, they are increasingly used even in patients without diabetes but with kidney disease.

Use in heart failure

SGLT2 inhibitors are now indicated in heart failure, even in non-diabetic patients.

Benefits include:

• symptom improvement
• reduced hospitalizations
• better quality of life

This is one of the rare situations in medicine where a “diabetes drug” becomes a cornerstone therapy for another major condition.

Differences between Forxiga and Jardiance

While their mechanism is the same, there are nuances:

• Jardiance:
  • stronger evidence for reducing cardiovascular mortality
  • often preferred in patients with very high cardiovascular risk
• Forxiga:
  • excellent data in heart failure and chronic kidney disease
  • widely used in nephrology settings

In practice, the differences are subtle and treatment is individualized.

Side effects and precautions

As with any therapy, there are risks:

• genital infections (especially fungal)
• urinary tract infections
• dehydration
• low blood pressure
• rare: Fournier’s gangrene (very rare but serious)

Patient education is essential for prevention.

Use in type 1 diabetes – an important warning

This is a critical topic.

Although the mechanism may seem beneficial in Type 1 diabetes, SGLT2 inhibitors are generally not recommended in routine practice.

The main concern is the risk of diabetic ketoacidosis, including a specific form called euglycemic ketoacidosis.

What does this mean?

• blood glucose may be normal or only mildly elevated
• but severe ketosis develops
• patients can become critically ill without classic warning signs

Mechanism:

• glucose loss reduces insulin requirements
• glucagon levels increase
• the body shifts toward fat metabolism → ketone production

Risk factors:

• excessive insulin dose reduction
• dehydration
• infections
• very low-carb or ketogenic diets

For this reason:

• use in type 1 diabetes is off-label
• it should only be considered in specialized centers
• strict ketone monitoring is required

This is not a theoretical risk—it is real and clinically significant.

Who are these medications best suited for?

They are particularly beneficial for:

• patients with type 2 diabetes
• individuals with overweight or obesity
• patients with high cardiovascular risk
• heart failure
• chronic kidney disease

They are among the few drugs that treat the patient as a whole, not just blood glucose.

Passing through Romania and need a prescription for your chronic treatment?

Contact Dr. Petrache’s Virtual Clinic for any medical issue you encounter while in Romania. Send an email to: clinica@diabet-si-nutritie.ro

Conclusion

Forxiga and Jardiance represent a major breakthrough in diabetology.

They:

• eliminate excess glucose through urine
• lower blood sugar without stressing the pancreas
• support weight loss
• protect the heart and kidneys

At the same time, they must be used appropriately—especially considering the risk of ketoacidosis in type 1 diabetes.

Choosing the right therapy is never about trends; it is about the individual patient. And that is where a personalized medical evaluation makes all the difference.

Follow us on:

• FaceBook: Diabetes & Nutrition;
• YouTube: Diabetes Facts.