Do SGLT2 inhibitors increase the risk of urogenital infections in patients with diabetes?

This study looked at the risk of urogenital infections in patients with diabetes taking sodium-glucose co-transporter 2 (SGLT2) inhibitors. It found that SGLT2 inhibitors increase the risk of urogenital infections in women over 50 years of age, especially in the first month of treatment.

SGLT 2 inhibitors such as canagliflozin (Invokana), dapagliflozin (Forxiga), and empagliflozin (Jardiance) are a type of medication used to treat type 2 diabetes (T2D). They work by increasing the amount of glucose that is eliminated in the urine. It has been suggested that increasing glucose (sugar) levels in the urine could increase the risk of urinary tract and genital infections (urogenital infections) in diabetic patients. However, the exact frequency of urogenital infections and which patients are more commonly affected when taking SGLT2 inhibitors is still unknown.

This study involved 2,949 patients with T2D. Patients were treated with SGLT2 inhibitors at various points during the study period. Patients were monitored for urogenital infections requiring antibiotic treatment. The risk of urogenital infection was then analyzed by looking at how many infections occurred when patients were on SGLT 2 inhibitors, compared to when they were not taking this treatment. 

Overall, the risk of having a urinary infection was 19% higher during the use of SGLT2 inhibitors compared to periods when patients were not using these medications. The risk of genital infections was 29% higher during the use of SGLT2 inhibitors compared to when these medications were not used.

Women over 50 years of age were 25% more likely to suffer from a urinary infection when on an SGLT2 inhibitor than when not taking this medication. The infection usually started within 8-14 days of starting the medication. Women over 50 years of age were also 44% more likely to suffer from a genital infection when taking an SGLT2 inhibitor. This usually started within 15-28 days of starting the medication. 

Men and younger women, had no increased risk of urogenital infection when taking an SGLT2 inhibitor.

This study showed that SGLT2 inhibitors increase the risk of urogenital infections in older women.

This study was unable to assess for other risk factors for urogenital infections, such as sexual intercourse. Further studies are needed.