Factors influence genital infection risk in women taking SGLT2 inhibitors

  • Nakhleh A & al.
  • J Diabetes Complicat
  • 18 Apr 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In women with type 2 diabetes (T2D) using sodium glucose co-transporter 2 inhibitors (SGLT2is), genital infection (GI) risk is greater with younger age, gastrointestinal history, and estrogen therapy.
  • Risk is lower with chronic kidney disease (CKD) and baseline dipeptidyl peptidase-4 inhibitor (DPP4i) use.

Why this matters

  • Both diabetes and SGLT2is increase GI risk, particularly among women.

Study design

  • Data analyzed for 6153 adult women with T2D from an Israeli health maintenance organization during March 2015-March 2018.
  • Funding: Marom.

Key results

  • During mean 2.3 years of follow-up, 25.1% had GIs.
  • Higher SGLT2i-proportion of days covered (SGLT2i-PDC) was associated with increased GI risk for SGLT2i-PDC ≥80% vs SGLT2i-PDC
  • GI diagnosed >30 days postindex date:
    • Adjusted (a)HR: 4.25 (P<.0001>
  • GI risk increased by 15% for each 10% increase in SGLT2i-PDC:
    • aHR: 1.015 (P<.001>
  • Increased GI risk was associated with (aHRs):
    • Age ≤55 vs >70 years: 1.74 (P<.001>
    • Prior GI history: 2.39 (P<.001>
    • Recent oral contraceptive/hormone replacement therapy use: 1.37 (P=.002).
  • Lower risk (aHRs) was associated with:
    • CKD: 0.84 (P=.001); and
    • Baseline DPP4i use: 0.89 (P=.019).
  • Limitations

    • Possible selection bias, residual confounding.
    • Milder GIs possibly excluded.
    • No data on antibiotic use, precise SGLT2i exposure timing.
    • Canagliflozin is unavailable in Israel.