Pharmacy and Health Blog from myGenericPharmacy.com

Yes, eating late in the evening—especially close to bedtime—can make blood sugar control more challenging for several reasons:

1. Reduced Insulin Sensitivity at Night

• The body’s insulin sensitivity tends to decrease in the evening, meaning it may not process glucose as efficiently as it does earlier in the day.
• Studies suggest that eating later can lead to higher post-meal blood sugar spikes compared to eating the same meal earlier.

2. Disruption of Circadian Rhythms

• The body’s internal clock (circadian rhythm) influences metabolism, including insulin secretion and glucose processing.
• Eating late may misalign with natural metabolic cycles, leading to poorer blood sugar regulation.

3. Increased Risk of Overnight High Blood Sugar

• Consuming carbohydrates or large meals late can keep blood sugar elevated overnight, which may lead to higher fasting blood sugar the next morning (a phenomenon known as the “dawn effect” in some cases).

4. Potential Weight Gain & Insulin Resistance

• Late-night eating has been linked to weight gain, which can further worsen insulin resistance over time.
• Snacking on high-carb or sugary foods at night can contribute to long-term metabolic issues.

Tips for Better Blood Sugar Control at Night:

Finish meals earlier – Aim to eat dinner at least 2-3 hours before bedtime.
Choose balanced meals – Include protein, fiber, and healthy fats to slow glucose absorption.
Avoid high-glycemic snacks – If hungry, opt for nuts, Greek yogurt, or veggies instead of sweets or refined carbs.
Monitor blood sugar – If diabetic or prediabetic, checking levels before bed can help adjust habits.

Reference:

https://www.everydayhealth.com/sleep/eating-a-late-dinner-can-spike-your-blood-sugar

https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/diabetes/faq-20058372

https://www.medicalnewstoday.com/articles/eating-late-in-the-evening-could-make-blood-sugar-control-harder-for-the-body

https://pmc.ncbi.nlm.nih.gov/articles/PMC5634913

Medications that have been suggested by doctors worldwide are available on below link

https://mygenericpharmacy.com/category/disease/diabetes

Yes! Research shows that 150 minutes of moderate-intensity exercise per week (about 30 minutes, 5 days a week) can significantly improve insulin sensitivity and help reverse prediabetes. Here’s how it works:

How Exercise Helps Reverse Prediabetes:

1. Improves Insulin Sensitivity – Exercise helps muscles use glucose more effectively, lowering blood sugar levels.
2. Reduces Belly Fat – Visceral fat (around organs) contributes to insulin resistance; exercise helps burn it.
3. Lowers Blood Sugar – Physical activity helps clear excess glucose from the bloodstream.
4. Boosts Metabolism – Regular exercise supports weight management, a key factor in preventing Type 2 diabetes.

Best Types of Exercise for Prediabetes:

• Aerobic Exercise (Brisk walking, cycling, swimming) – Helps burn glucose and improve heart health.
• Strength Training (Weight lifting, resistance bands) – Builds muscle, which absorbs more glucose.
• HIIT (High-Intensity Interval Training) – Short bursts of intense exercise can improve insulin sensitivity quickly.

Additional Tips to Reverse Prediabetes:

• Combine exercise with a healthy diet (low in refined carbs, high in fiber & protein).
• Lose 5-7% of body weight if overweight—this can cut diabetes risk by 58%.
• Monitor blood sugar levels to track progress.
• Reduce sedentary time (take short walks after meals).

150 minutes of exercise per week is a powerful tool to reverse prediabetes, especially when combined with dietary changes. If you’re just starting, even 10-minute sessions throughout the day can make a difference. Always consult a doctor before beginning a new fitness plan.

Reference:

https://www.news-medical.net/news/20250629/Just-150-minutes-of-exercise-a-week-could-reverse-prediabetes.aspx

https://www.medicalnewstoday.com/articles/150-minutes-of-exercise-per-week-could-help-reverse-prediabetes

https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/just-150-minutes-of-exercise-a-week-could-reverse-prediabetes/articleshow/122154898.cms

Medications that have been suggested by doctors worldwide are available on below link

https://mygenericpharmacy.com/category/disease/diabetes

Yes! Emerging research suggests that avoiding diet soda and choosing water may support diabetes remission or better blood sugar control. Here’s why:

1. Diet Soda & Metabolic Risks

• Artificial sweeteners (e.g., aspartame, sucralose) in diet soda may:
  • Disrupt gut microbiota, linked to insulin resistance (Nature, 2014).
  • Trigger cravings for sweet/high-calorie foods, worsening metabolic health.
  • Some studies associate diet soda with higher type 2 diabetes risk (Diabetes Care, 2009), though causation isn’t fully proven.

2. Water’s Benefits for Diabetes Remission

• Hydration improves insulin sensitivity—even mild dehydration can raise blood sugar.
• Replacing sugary drinks (and diet soda) with water reduces calorie intake and supports weight loss, a key factor in remission (DiRECT trial, 2018).
• Sparkling/mineral water (unsweetened) is a safe alternative if craving fizz.

3. What Works Best for Remission?

• Low-carb/keto diets and intermittent fasting often lead to remission by lowering insulin resistance.
• Whole foods (fiber, healthy fats) stabilize blood sugar better than artificial sweeteners.
• Exercise further enhances insulin sensitivity.

If you’re used to diet soda, try infused water (e.g., lemon/cucumber) or herbal teas to transition. Cutting out sweeteners may help reset taste buds and reduce sugar cravings over time.

Reference:

https://www.everydayhealth.com/diabetes/ditching-diet-soda-tied-to-weight-loss-and-higher-chance-of-diabetes-remission

https://www.medicalnewstoday.com/articles/to-achieve-diabetes-remission-avoid-diet-soda-and-opt-for-water

https://www.prnewswire.com/news-releases/water-instead-of-diet-drinks-associated-with-two-fold-rate-of-diabetes-remission-in-women-302486589.html

https://www.medscape.com/viewarticle/switch-water-diet-sodas-may-boost-diabetes-remission-2025a1000gkq

Medications that have been suggested by doctors worldwide are available on below link

https://mygenericpharmacy.com/category/disease/diabetes

Yes! Recent research suggests that a fasting-mimicking diet (FMD)—a short-term, low-calorie, low-protein, high-fat dietary intervention designed to mimic the effects of fasting—may help improve blood sugar control in individuals with type 2 diabetes (T2D) while minimizing risks associated with prolonged fasting.

Key Findings on FMD & Blood Sugar Control:

1. Reduces Insulin Resistance & Improves Glycemic Markers
   • Studies show that cyclical FMD (e.g., 5-day monthly cycles) can lower fasting glucose, HbA1c, and insulin resistance (HOMA-IR).
   • May promote beta-cell regeneration and pancreatic reprogramming, enhancing insulin sensitivity.
2. Promotes Metabolic Switching to Ketosis
   • By restricting calories (~800-1,100 kcal/day) and carbohydrates, FMD induces ketosis, forcing the body to burn fat and ketones instead of glucose.
   • This metabolic shift may reduce glucose toxicity and improve mitochondrial function.
3. Supports Weight Loss & Visceral Fat Reduction
   • FMD cycles lead to moderate weight loss, particularly in visceral fat, which is strongly linked to insulin resistance.
   • Unlike crash diets, FMD appears sustainable when done intermittently (e.g., once a month).
4. Potential for Reducing Diabetes Medication Dependence
   • Some trials report that T2D patients on FMD needed lower doses of insulin or oral hypoglycemics after multiple cycles.
   • Caution is needed to avoid hypoglycemia, especially in those on glucose-lowering drugs.

How FMD Works in Diabetes:

• Day 1-5 (FMD Phase):
  • Very low calories (~34-54% of normal intake), low protein, high healthy fats (nuts, olive oil).
  • Triggers autophagy (cellular cleanup) and stem cell activation, which may repair pancreatic function.
• Post-FMD (Refeeding Phase):
  • Gradual reintroduction of normal eating helps reset metabolism without rapid glucose spikes.

Clinical Evidence:

• A 2023 study in Diabetes Care found that 3 monthly FMD cycles improved HbA1c by ~0.5–1.2% in prediabetics and early T2D patients.
• Animal studies show FMD can reverse insulin resistance and restore beta-cell function.

Safety & Considerations:

• Not for everyone: Avoid in advanced diabetes, pregnancy, or eating disorders.
• Medical supervision needed: Especially for those on insulin or sulfonylureas (risk of hypoglycemia).
• Combination with lifestyle changes: Works best alongside exercise and a Mediterranean/low-glycemic diet.

FMD is a promising non-pharmacological tool for managing T2D by resetting metabolism, but it requires careful implementation. Future studies will clarify long-term benefits and optimal protocols.

Reference:

https://www.medicalnewstoday.com/articles/a-fasting-mimicking-diet-may-improve-blood-sugar-control-in-type-2-diabetes

https://pubmed.ncbi.nlm.nih.gov/38546821

https://www.annfammed.org/content/21/Supplement_3/5005

Medications that have been suggested by doctors worldwide are available on below link

https://mygenericpharmacy.com/category/disease/diabetes

Invokana is a brand-name prescription drug. It’s FDA-approved for use in adults with type 2 diabetes to:

Improve blood sugar levels. For this use, Invokana is prescribed in addition to diet and exercise to lower blood sugar levels. Reduce the risk of certain cardiovascular problems. For this use, Invokana is given to adults with known cardiovascular disease. It’s used to lower the risk of heart attack and stroke that don’t lead to death. The drug is used to reduce the risk of death from a heart or blood vessel problem.
Reduce the risk of certain complications in people who have diabetic nephropathy with albuminuria. For this use, Invokana is given to certain adults who have diabetic nephropathy (kidney damage that’s caused by diabetes) with albuminuria* of greater than 300 milligrams per day. It’s used to lower the risk of:
End-stage kidney disease
death caused by a heart or blood vessel problem
doubled blood level of creatinine
the need to be hospitalized for heart failure
For more information about these uses of Invokana and certain limitations of its use, see the “Invokana uses” section below.

• With albuminuria, you have high levels of a protein called albumin in your urine.

Drug details
Invokana contains the drug canagliflozin. It belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT-2) inhibitors. (A drug class describes a group of medications that work similarly.)

Invokana comes as a tablet that’s taken by mouth. It’s available in two strengths: 100 mg and 300 mg.

Effectiveness
For information on Invokana’s effectiveness for its approved uses, see the “Invokana uses” section below.

Invokana generic
Invokana contains one active drug ingredient: canagliflozin. It’s available only as a brand-name medication. It’s not currently available in generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Invokana side effects
Invokana can cause mild or serious side effects. The following list contains some key side effects that may occur while taking Invokana. This list doesn’t include all possible side effects.

To learn more about possible side effects of Invokana or how to manage them, talk with your doctor or pharmacist.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Invokana, you can do so through MedWatch.

More common side effects
The more common side effects of Invokana can include*:

urinary tract infections / urinating more often than normal / thirstiness / constipation / nausea / yeast infections† in men and women / vaginal itching.

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist. You should also call your doctor if you think you have a urinary tract infection or yeast infection.

• This is a partial list of more common side effects from Invokana. To learn about other mild side effects, talk with your doctor or pharmacist or visit Invokana’s medication guide.
  † For more information about this side effect, see the “Side effect details” section just below.

Serious side effects
Serious side effects from Invokana aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

Dehydration (low fluid level), which can cause low blood pressure. Symptoms can include:
dizziness/feeling faint/lightheadedness/weakness, especially when you stand up
Hypoglycemia (low blood sugar level). Symptoms can include:
drowsiness/headache/confusion/weakness/hunger/irritability/sweating/feeling jittery/fast heartbeat
Severe allergic reaction.*
Amputation of lower limbs.*
Diabetic ketoacidosis (increased levels of ketones in your blood or urine).*
Fournier’s gangrene (severe infection near the genitals).*
Kidney damage.* Bone fractures.*

Side effect details
You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction
As with most drugs, some people can have an allergic reaction after taking Invokana. In clinical studies, up to 4.2% of people taking Invokana reported having mild allergic reactions.

Symptoms of a mild allergic reaction can include:

skin rash/itchiness/flushing (warmth, swelling, or redness in your skin)
A more severe allergic reaction is rare but possible. Only a few people in clinical studies reported severe allergic reactions while taking Invokana.

Symptoms of a severe allergic reaction can include:

swelling under your skin, typically in your eyelids, lips, hands, or feet
swelling of your tongue, mouth, or throat/trouble breathing
Call your doctor right away if you have a severe allergic reaction to Invokana. But call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Amputation
Invokana may increase your risk of amputation of lower limbs. (With amputation, one of your limbs is removed.)

Two studies found an increased risk for lower limb amputation in people who took Invokana and had:

type 2 diabetes and heart disease, or
type 2 diabetes and were at risk for heart disease
In the studies, up to 3.5% of the people who took Invokana had an amputation. Compared with people who didn’t take the drug, Invokana doubled the risk of amputation. The toe and the midfoot (arch area) were the most common areas of amputation. Some leg amputations were also reported.

Before you start taking Invokana, talk with your doctor about your risk of amputation. This is especially important if you’ve had an amputation in the past. It’s also important if you have a blood circulation or nerve disorder, or diabetic foot ulcers.

Call your doctor right away and stop taking Invokana if you:

feel new foot pain or tenderness
have foot sores or ulcers
get a foot infection
Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. If you develop symptoms or conditions that increase your risk for lower limb amputation, your doctor may have you stop taking Invokana.

Yeast infection
Taking Invokana increases your risk of a yeast infection. This is true for both men and women, according to data from clinical trials. In the trials, up to 11.6% of the women and 4.2% of the men had a yeast infection.

You’re more likely to develop a yeast infection if you’ve had one in the past or if you’re an uncircumcised male.

If you get a yeast infection while taking Invokana, talk with your doctor. They can suggest ways to treat it.

Diabetic ketoacidosis
Although it’s rare, some people who take Invokana can develop a serious condition called diabetic ketoacidosis. This condition occurs when cells in your body don’t get the glucose (sugar) they need for energy. Without this sugar, your body uses fat for energy. And this can lead to high levels of acidic chemicals called ketones in your blood.

Symptoms of diabetic ketoacidosis can include:

excessive thirst/urinating more often than normal/nausea/vomiting/stomach pain/tiredness/weakness/shortness of breath/breath that smells fruity/confusion
In severe cases, diabetic ketoacidosis can cause coma or death. If you think you may have diabetic ketoacidosis, call your doctor right away. But if your symptoms are severe, call 911 or go to the nearest emergency room.

Before you start taking Invokana, your doctor will assess your risk for developing diabetic ketoacidosis. If you have an increased risk of this condition, your doctor may monitor you closely during treatment. And in some cases, such as if you’re having surgery, they may have you temporarily stop taking Invokana.

Fournier’s gangrene
Fournier’s gangrene is a rare infection in the area between your genitals and rectum. Symptoms can include:

pain, tenderness, swelling, or reddening in your genital or rectal area
fever malaise (overall feeling of discomfort)
People in clinical trials of Invokana didn’t get Fournier’s gangrene. However after the drug was approved for use, some people reported having Fournier’s gangrene while taking Invokana or other drugs in the same drug class. (A class of drugs describes a group of medications that work in the same way.)

More serious cases of Fournier’s gangrene have led to hospitalization, multiple surgeries, or even death.

If you think you may have developed Fournier’s gangrene, call your doctor right away. They may want you to stop taking Invokana. They will also recommend treatment for the infection.

Kidney damage
Taking Invokana can increase your risk of kidney damage. Symptoms of kidney damage can include:

urinating less often than normal
swelling in your legs, ankles, or feet
confusion
fatigue (lack of energy)
nausea
chest pain or pressure
irregular heartbeat
seizures
After the drug was approved for use, some people taking Invokana reported that their kidneys worked poorly. When these people stopped taking Invokana, their kidneys began to work normally again.

You’re more likely to have kidney problems if you:

are dehydrated (have a low fluid level)
have kidney or heart problems
take other medications that affect your kidneys
are older than age 65
Before you start taking Invokana, your doctor will test how well your kidneys are working. If you have kidney problems, you may not be able to take Invokana.

Your doctor may also test how your kidneys are working during your treatment with Invokana. If they detect any kidney problems, they may change your dose or stop your treatment with the drug.

Bone fractures
In a clinical study, some people who took Invokana experienced bone fractures (broken bones). The fractures weren’t usually severe.

Symptoms of bone fracture can include:

pain/swelling/tenderness/bruising/deformity
If you’re at high risk for a fracture or if you’re concerned about breaking a bone, talk with your doctor. They can suggest ways to help prevent this side effect.

Falls: In nine clinical trials, up to 2.1% of people who took Invokana had a fall. There was a higher risk of falls in the first few weeks of treatment.

If you have a fall while taking Invokana or if you’re concerned about falling, talk with your doctor. They can suggest ways to help prevent this side effect.

Pancreatitis (not a side effect)

Pancreatitis (inflammation in your pancreas) was extremely rare in clinical trials. Rates of pancreatitis were similar between people who took Invokana and those who took a placebo (treatment without active drug). Because of these similar results, it’s not likely that Invokana caused the pancreatitis.

If you have concerns about developing pancreatitis with Invokana, talk with your doctor.

Joint pain (not a side effect): Joint pain wasn’t a side effect of Invokana in any clinical trials.

However, some other diabetes drugs may cause joint pain. In fact, the Food and Drug Administration (FDA) released a safety announcementTrusted Source for a class of diabetes drug called dipeptidyl peptidase-4 (DPP-4) inhibitors. (A drug class describes a group of medications that work in the same way.) The announcement said that DPP-4 inhibitors may cause severe joint pain.

But Invokana doesn’t belong to that drug class. Instead, it belongs to a class of drugs called sodium-glucose co-transporter-2 (SGLT2) inhibitors.

If you have concerns about joint pain with Invokana use, talk with your doctor.

Hair loss (not a side effect)/Hair loss wasn’t a side effect of Invokana in any clinical trials.

If you’re concerned about hair loss, talk with your doctor. They can help you determine what’s causing it and ways to treat it.

Invokana dosage
The Invokana dosage your doctor prescribes will depend on several factors. These include:

the type and severity of the condition you’re using Invokana to treat
your age
other medical conditions you may have
how well your kidneys are working
certain other medications you may be taking with Invokana
Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths
Invokana comes as a tablet. It’s available in two strengths:

100 milligrams (mg), which comes as a yellow tablet
300 mg, which comes as a white tablet
Dosage for lowering blood sugar levels
Recommended dosages of Invokana to lower blood sugar levels are based on a measurement called estimated glomerular filtration rate (eGFR). This measurement is done using a blood test. And it shows how well your kidneys are working.

In people with an:

eGFR of at least 60, they have no loss of kidney function to mild loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily. Their doctor may increase their dosage to 300 mg once daily if needed to help manage their blood sugar level.
eGFR of 30 to less than 60, they have mild-to-moderate loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily.
eGFR of less than 30, they have severe loss of kidney function. It’s not recommended that they begin using Invokana. But if they’ve already been using the drug and are passing a certain level of albumin (a protein) in their urine, they may be able to continue taking Invokana.*
Note: Invokana shouldn’t be used by people who are using dialysis therapy. (Dialysis is a procedure that’s used to clear waste products from your blood when your kidneys aren’t healthy enough to do so.)

• For this use, people would be taking Invokana at a dosage of 100 mg to lower the risk of certain complications of diabetic nephropathy. See the “Invokana uses” section for more information.

Dosage for reducing cardiovascular risks
Recommended dosages of Invokana to reduce cardiovascular risks are the same as they are to lower blood sugar levels. See the section above for details.

Dosage for reducing the risk of complications from diabetic nephropathy
Recommended dosages of Invokana to lower the risks of complications from diabetic nephropathy are the same as they are to lower blood sugar levels. See the section above for details.

What if I miss a dose?
If you miss a dose of Invokana, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take the next dose at the normal time. Don’t try to catch up by taking two doses at once. This can cause dangerous side effects.

Using a reminder tool can help you remember to take Invokana every day.

Be sure to take Invokana only as your doctor prescribes.

Will I need to use this drug long-term?
If you and your doctor agree that Invokana is working well for you, you’ll likely use it long-term.

SAN DIEGO The significant kidney and cardiovascular benefits of people with chronic kidney disease (CKD) show over 2 years of treatment with empagliflozin begin to subside within about a year after treatment discontinuation, suggesting the need for ongoing treatment.

We know that empagliflozin is safe we know it works and now we know we need to keep people on the treatment to maximize the benefits, said first author William G. Herrington, MD, of the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK, at a press briefing at the American Society of Nephrology (ASN) Kidney Week 2024.

The New England Journal of Medicine published the study at the same time. Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that was discontinued early in the EMPA-KIDNEY trial because of its effectiveness in lowering the risk of kidney disease or its progression in patients with a variety of kidney disease causes and kidney function levels. The study demonstrated that empagliflozin decreased the primary outcome of kidney disease progression or cardiovascular death by 28% compared to a placebo, with no significant safety concerns, over a median follow-up of two years.

Herrington and colleagues examined data on 4891 (74 percent) of the 6609 CKD patients who participated in an extra 2-year post-trial observational period to better examine the changing effects of the medication following discontinuation. Adult patients with CKD-EPI estimated glomerular filtration rate (eGFR) of 20 to 45 mL/min/1.73 m2 or 45 to 90 mL/min/1.73 m2 plus urine albumin-to-creatinine of ≥ 200 mg/g were specifically included in the study. In the post-trial randomization, the average age was 63 years, 34% of the participants were female, and roughly 57% of both groups had never had diabetes before. About 35% of each group had a mean eGFR of less than 30 mL/min/1.73 m2, while the mean eGFR was 37 mL/min/1.73 m2.

Patients were randomized to receive a matching placebo or 10 mg of empagliflozin once daily. During the post-trial phase, neither placebo nor trial-related empagliflozin was given. However, open-label SGLT2 inhibitors, such as empagliflozin, were administered to patients as directed by their physicians. Similarly, during the post-trial phase, open-label SGLT2 inhibitors were utilized by 40% of the placebo group and 43% of the empagliflozin group.

Herrington stated that an evaluation for any carry-over effects is made possible by the absence of a between-group difference in SGLT2 inhibitor use after the trial. The primary outcome, a composite of kidney disease progression or cardiovascular death, was observed in 865 out of 3304 patients (26.2 percent) in the empagliflozin group compared to 1001 out of 3305 patients (30.3 percent) in the placebo group when the effects from the active and post-trial periods were combined (hazard ratio [HR], 0.79; P < .0001).

The hazard ratio for the primary outcome was still significant during the post-trial period. Still, it was less so at 0.87 (P = .04). Regarding other specific outcomes, the risk of kidney disease progression during the combined periods was 23 percent for the empagliflozin group and 27 percent for the placebo group; the risk of cardiovascular death was 3 point 8 percent and 4 point 9 percent, respectively; and the risk for the composite of death or end-stage kidney disease was 16 point 9 percent with empagliflozin and 19 point 6 percent with placebo. The percentage of deaths from noncardiovascular causes (5.3% in both groups) did not differ between the groups.

According to Herrington, the carry-over effect was only about a year long and reduced the risk for the primary outcome by 13 percent overall, which was less than the 28 percent reduction that occurred while taking empagliflozin during the active trial. According to the authors, the effects of empagliflozin were seen after the follow-up regardless of the degree of albuminuria, diabetes status, kidney function level, and primary kidney diagnosis. According to the study, analyses of the long-term eGFR slope from the active-trial period also revealed that empagliflozin slowed the progression of all albuminuria subgroups.

Finally, they conclude that the results show that the benefit after the trial was less than the benefit during the study treatment and seemed to be transient. Therefore, long-term CKD treatment is necessary to optimize the cardiorenal clinical benefits of SGLT2 inhibitors. Emily Chang, MD, an associate professor of medicine at the University of North Carolina, Chapel Hill’s Division of Nephrology and Hypertension, commented on the study and agreed that the results offer valuable information about the possible consequences for patients, irrespective of their disease stage, who stop taking empagliflozin.

Chang told Medscape Medical News, “I think it is important to know that these are probably lifelong drugs, although I have already been operating under that premise in my practice at least.”. However, knowing that this is probably the best course of action is comforting. Regarding comparable effects with other SGLT2 inhibitors, Chang speculated that this effect would hold true for all SGLT2 inhibitor classes, though we can’t be certain until more research is conducted. A patient’s ability to take the medication will be limited if they are unable to tolerate it, she continued. Otherwise, I intend to keep these patients taking this medication for the rest of their lives if it is tolerated.

Pietro Canetta, MD, an associate professor of medicine in the Division of Nephrology at Columbia University Irving Medical Center in New York, added that while there is a wealth of information about the advantages of SGLT2 inhibitors during treatment, this study was noteworthy for demonstrating that a significant portion of the benefits appeared to last for at least a year after the study populations stopped taking the prescribed medication.

Although we cannot definitively determine the mechanism from this trial, the strong effect that persisted even after stopping the drug highlights that there appear to be advantages beyond its immediate effects. For instance, he said, they might be promoting better vascular health or beneficial remodeling.

Important disclaimers were mentioned by Canetta, who told Medscape Medical News that patients with a history of ketoacidosis or recent immunosuppression were not included and that patients had to be taking an adequate dosage of an RAS [renin-angiotensin system] inhibitor. Furthermore, he added, it’s critical to remember that the advantages were different when taken off a drug than when taken on one. Although the group that initially received empagliflozin outperformed the group that initially received a placebo, the difference was more noticeable while both groups were taking the study medication.

This is significant because, according to Canetta, the trial’s message shouldn’t be taken to imply that you can quit after a year and still anticipate the same advantages indefinitely. The main takeaway from this is that there is more proof that these medications are a great addition to our toolbox for slowing the progression of kidney disease and cardiovascular consequences.

References:
https://www.medscape.com/viewarticle/empagliflozin-effects-subside-discontinuation-2024a1000jm9