SGLT2 inhibitors use linked to genital mycotic infection risk in older adults

  • Lega IC & al.
  • Diabetes Obes Metab
  • 10 Jul 2019

  • International Clinical Digest
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Takeaway

  • Sodium glucose cotransporter 2 inhibitors (SGLT2is) are tied to increased 30-day risk for genital mycotic infections but not urinary tract infections (UTIs) among adults age >65 years.

Why this matters

  • Adults >65 years have increased risk for T2D and genitourinary infections.

Study design

  • Retrospective database review of 21,444 and 22,463 new users of SGLT2is and dipeptidyl-peptidase-4 inhibitors (DPP4is), respectively.
  • Funding: Canadian Institutes of Health Research.

Key results

  • Absolute 30-day risk difference for genital mycotic infections between new SGLT2i vs DPP4i users was (95% CIs):
    • Overall: 1.21% (0.97%-1.45%); 
    • Women: 2.04% (1.59%-2.48%); and 
    • Men: 0.69% (0.43%-0.95%).
  • Adjusted for propensity score, age, sex, recent antibiotic use, 30-day risk for genital mycotic infection with new SGLT2i use (HRs; 95% CIs):
    • Overall: 2.47 (2.08-2.92);
    • Women: 2.56 (2.06-3.17); and
    • Men: 2.30 (1.74-3.02).
  • Absolute risk difference in UTIs (95% CIs):
    • Overall: −1.08% (−1.39% to −0.77%); 
    • Women: −1.23% (−1.77% to −0.69%); and
    • Men: −0.82% (−1.18% to −0.46%).
  • SGLT2i use did not increase UTI risk vs DPP4is (HRs; 95% CIs):
    • Overall: 0.89 (0.78-1.00);
    • Women: 0.89 (0.76-1.05); and
    • Men: 0.88 (0.73-1.07).

Limitations

  • No glycaemic control, adherence, hospitalisation data.
  • Reliance on prescription claims, no data on over-the-counter antimycotic medication use.

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