When I first started practicing, type 2 diabetes was something I almost never saw in a child’s chart. It was an adult disease, full stop. That’s changed dramatically, and not in a good way. Rates of type 2 diabetes in children and teenagers have been climbing steadily for years, and for a long time, the medicine cabinet for these young patients was nearly empty. Metformin, insulin, and a couple of injectable options were really all we had to offer. So, when I heard that two well-known SGLT2 inhibitors, dapagliflozin (Farxiga) and empagliflozin (Jardiance), have now been approved for children as young as 10, I sat up and paid attention. This isn’t a minor label update. It’s a meaningful expansion of options for families who, until now, had very few paths forward.
In simple terms: children with type 2 diabetes now have effective oral add-on options beyond metformin and injections.
Let me back up and explain what SGLT2 inhibitors actually do, because the name sounds intimidating but the concept is fairly simple. These medications work on the kidneys, blocking a protein that normally reabsorbs glucose back into the bloodstream. When that protein is blocked, extra glucose gets flushed out through urine instead of recirculating. The net effect is lower blood sugar, achieved through the kidneys rather than the pancreas or liver. In adults, this class of drugs has already proven itself well beyond diabetes, with benefits for heart failure and chronic kidney disease too.
For pediatric type 2 diabetes, dapagliflozin’s approval is the result of years of trial work. According to findings from the T2NOW trial, published in NEJM Evidence, children and adolescents aged 10 to 17 who were already on metformin, insulin, or both saw meaningful improvements in their HbA1c after adding dapagliflozin to their regimen. Over 26 weeks, those on the 5 mg dose experienced a notable drop in HbA1c compared with placebo, about a 0.6% reduction, a clinically meaningful improvement in diabetes care. Some participants whose blood sugar wasn’t controlled well enough at the 12-week mark were moved up to a 10 mg dose, and that group continued to show improvement through the rest of the study. The trial also tracked safety for a full year, and researchers didn’t flag any new safety concerns beyond what’s already known about this drug class in adults.
This wasn’t dapagliflozin’s first time being studied in younger patients, either. The European Medicines Agency actually extended dapagliflozin’s approval to children 10 and older back in 2021, based on earlier phase 3 data. The more recent U.S. approval brought American families into step with what European clinicians had already been able to offer for a few years.
Empagliflozin’s pediatric approval tells a similar story, built on a trial called DINAMO. According to the DINAMO trial, published in The Lancet Diabetes & Endocrinology, researchers compared empagliflozin against placebo in young people aged 10 to 17 with type 2 diabetes who were already on background therapy like metformin or insulin. The study found that empagliflozin, at both 10 mg and 25 mg doses, reduced HbA1c by about 0.84 percentage points compared with placebo at 26 weeks. That’s a solid result, and importantly, the drug hit its primary goal cleanly.
Based on this data, the U.S. Food and Drug Administration approved not just empagliflozin (Jardiance) on its own, but also the combination pill Synjardy, which pairs empagliflozin with metformin, giving prescribers more flexibility in how they build a treatment plan.
What strikes me most about both approvals are what they represent for day-to-day life. Before this, if a child’s metformin wasn’t cutting it anymore, the next options were often injectable, whether that meant insulin or one of the GLP-1 receptor agonists. Asking a ten-year-old, or their parent, to manage daily injections on top of school, sports, and everything else that comes with being a kid is a real burden. Having an oral, once-daily tablet that can be added onto existing therapy is a genuinely practical shift, not just a clinical one.
Now, I’d be doing you a disservice if I didn’t mention the safety side of things, because no medication is free of trade-offs.
The most common issue
The most consistently reported issue with SGLT2 inhibitors, in both adults and the younger patients in these trials, is an increased risk of genitourinary infections, things like yeast infections and urinary tract infections. The American Diabetes Association Standards of Care in Diabetes specifically notes that families and young patients should be counseled about this increased risk. In practice, that usually means good hygiene habits, staying on top of hydration, and not ignoring symptoms like burning during urination or unusual discharge, since these are very treatable when caught early.
A rarer but serious risk
There’s also a rarer but more serious concern worth knowing about: diabetic ketoacidosis, which can occasionally occur with SGLT2 inhibitors even when blood sugar isn’t dramatically elevated. This is uncommon, but parents and caregivers should know the warning signs, things like nausea, vomiting, abdominal pain, unusual fatigue, and fruity smelling breath, and understand “sick day rules,” which often involve pausing the medication temporarily during illness, vomiting, or before surgery. This is exactly the kind of conversation worth having with your pharmacist or your child’s endocrinologist before starting treatment, not after a problem comes up.
Who may not be suitable
These medications aren’t appropriate for every child, especially those with certain kidney conditions or a history of recurrent infections, something a clinician will carefully assess before prescribing.
I also want to gently push back on any temptation to see this as “just another pill to add.” Type 2 diabetes in children is almost always tied up with broader factors: weight, activity levels, sleep, family history, and sometimes food access and routines at home. Medication can be an important piece of the puzzle, especially when lifestyle changes alone haven’t brought HbA1c into a healthy range, but it works best as part of a bigger picture that includes nutrition support, physical activity the child actually enjoys, and regular follow-up.
If your child has recently been prescribed dapagliflozin or empagliflozin, or if your pediatrician has mentioned it as a possibility, this is a great moment to ask questions. What dose are we starting at? How will we know it’s working? What should we watch for at home? Your pharmacist is one of the most accessible people to ask, and honestly, these are conversations I genuinely enjoy having. Getting comfortable with a new medication early on tends to make everything that follows go more smoothly.
For the first time in years, we’re not just managing childhood type 2 diabetes, we’re expanding real, practical choices. And that changes how families live with this condition every day.
FAQs
Q1. At what age can children now take Farxiga or Jardiance for type 2 diabetes?
Both dapagliflozin (Farxiga) and empagliflozin (Jardiance), including the combination pill Synjardy, are now approved for children and adolescents aged 10 to 17 with type 2 diabetes, typically as an add-on to existing treatment like metformin or insulin.
Q2. How do SGLT2 inhibitors actually lower blood sugar?
They work on the kidneys, blocking a transporter protein that normally pulls glucose back into the bloodstream. With that transporter blocked, extra glucose is removed from the body through urine, which helps bring blood sugar levels down.
Q3. What are the most common side effects parents should watch for?
The most frequently reported issue in trials was an increased risk of genitourinary infections, such as urinary tract infections and yeast infections. Staying well hydrated and maintaining good hygiene can help reduce this risk.
Q4. Can these medications replace insulin in children with type 2 diabetes?
Not necessarily. In the trials supporting these approvals, dapagliflozin and empagliflozin were used as add-on therapies alongside metformin or insulin rather than as standalone replacements. Any changes to insulin dosing should always be guided by the prescribing physician.
Q5. What should families know about “sick day” precautions?
SGLT2 inhibitors carry a rare risk of diabetic ketoacidosis, even when blood sugar isn’t very high. Families should learn the warning signs, including nausea, vomiting, abdominal pain, and unusual tiredness, and talk to their care team about temporarily pausing the medication during illness, vomiting, or before any planned surgery.
Call to Action
If you found this helpful, I’d encourage you to explore more of my articles on pharmahealths.com, where I break down other diabetes medication updates, blood sugar management tips, and everyday questions about pediatric and adult metabolic health. I write these pieces to help make sense of fast-moving medical news, so there’s plenty more to dig into if this topic interests you.
Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your child’s pediatrician, endocrinologist, or pharmacist before starting, stopping, or changing any medication.
References
• NEJM Evidence
• The Lancet Diabetes & Endocrinology
• American Diabetes Association Standards of Care in Diabetes
• U.S. Food and Drug Administration
• European Medicines Agency