Black Health
SGLT2 inhibitor Type 2 diabetes Heart failure (reduced + preserved EF) CKD

Empagliflozin (Jardiance, Synjardy, Glyxambi) and Black patients

Brand names: Jardiance, Synjardy, Glyxambi

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What Empagliflozin does

Empagliflozin blocks the SGLT2 transporter in the kidney, causing glucose to be excreted in urine rather than reabsorbed. Beyond lowering blood sugar, it has proven mortality benefit in heart failure (both reduced and preserved ejection fraction), slows chronic kidney disease progression, and reduces cardiovascular death in type 2 diabetes with CV risk.

What the evidence says for Black patients

Empagliflozin's outcome evidence in Black patients is robust across multiple landmark trials:

  • EMPA-REG OUTCOME (Zinman et al., NEJM 2015;373:2117–28, PMID 26378978) — 38 percent reduction in cardiovascular death in type-2 diabetes with established CVD. Black subgroup was small (roughly 5 percent) but directionally consistent.
  • EMPEROR-Reduced (Packer et al., NEJM 2020;383:1413–24, PMID 32865377) — reduced HF hospitalization and CV death in HFrEF.
  • EMPEROR-Preserved (Anker et al., NEJM 2021;385:1451–61, PMID 34449189) — first positive HFpEF trial; Black subgroup benefit consistent.
  • EMPA-KIDNEY (Herrington et al., NEJM 2023;388:117–27, PMID 36331190) — slowed CKD progression.

Because Black adults carry elevated rates of HFrEF, HFpEF, and CKD, SGLT2 inhibitors as a class arguably offer disproportionate benefit. 2022 AHA/ACC/HFSA heart-failure guidelines give SGLT2 inhibitors a class I (strongest) recommendation regardless of race. APOL1 nephropathy — a Black-ancestry-enriched CKD risk — is responsive to SGLT2 therapy based on CREDENCE and DAPA-CKD post-hoc analyses.

Prescribing gap: as with GLP-1s, Black adults are under-prescribed SGLT2 inhibitors relative to clinical need (Eberly et al., JAMA 2021;326:2381–90, PMID 34910100).

Common alternatives

Dapagliflozin (Farxiga) and canagliflozin (Invokana) are other SGLT2 inhibitors with overlapping outcome evidence. Canagliflozin has the largest Black-subgroup data (CREDENCE trial, NEJM 2019;380:2295–306). For diabetes alone without CV or kidney indication, metformin remains first-line.

Side effects

  • Genital mycotic infections (especially women and uncircumcised men)
  • Urinary tract infections
  • Volume depletion, orthostatic hypotension
  • Euglycemic DKA — rare but life-threatening; hold before major surgery
  • Fournier's gangrene — very rare but FDA-labeled; educate on perineal pain
  • Small rise in LDL, small rise in creatinine (expected)

Factors that affect adherence

Genital infections cause embarrassment-driven discontinuation; counseling on hygiene and OTC antifungal availability matters. Cost has fallen significantly as generics approach market, but brand pricing remains $400–600/month without insurance. Medicare Part D and most Medicaid plans cover it for HF and CKD indications.

Questions to ask your doctor

Bring this list to your next appointment.

  • If I have HF or CKD, am I on an SGLT2 inhibitor? If not, why?
  • What do I do if I get a UTI or yeast infection?
  • Should I stop this before surgery?
  • How will my blood pressure and kidney function be monitored?

References

  1. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes (EMPA-REG OUTCOME). NEJM. 2015;373:2117–2128. PMID 26378978.
  2. Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure (EMPEROR-Reduced). NEJM. 2020;383:1413–1424. PMID 32865377.
  3. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction (EMPEROR-Preserved). NEJM. 2021;385:1451–1461. PMID 34449189.
  4. Herrington WG, Staplin N, Wanner C, et al. Empagliflozin in patients with chronic kidney disease (EMPA-KIDNEY). NEJM. 2023;388:117–127. PMID 36331190.
  5. Eberly LA, Yang L, Eneanya ND, et al. Racial/ethnic and socioeconomic disparities in SGLT2 inhibitor use among US adults with type 2 diabetes. JAMA. 2021;326:2381–2390. PMID 34910100.

Medical disclaimer

This page is patient education, not prescribing guidance. It summarizes the published evidence about how this medication has been studied in Black patients — it is not a substitute for the judgment of your personal clinician. Never start, stop, or change a prescription based on something you read here. If you have questions about your medication, call your prescriber or pharmacist. For emergencies, call 911.

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