Study highlights risk factors of genital infections with SGLT2i

Why this matters

• Findings can be used by physicians to stratify the risk of genital infections over the first year of SGLT2i treatment.

Study design

• This retrospective cohort analysis included 21,008 patients with T2D initiating SGLT2i and 55,481 control participants initiating DPP4i within a large UK population-based cohort.
• Funding: None disclosed.

Key results

• Genital infections were more common within the first year of treatment in patients treated with SGLT2i (8.1%; 95% CI, 7.6-8.5%) vs. those treated with DPP4i (1.8%; 95% CI, 1.7-1.9%).
• The risk factors of genital infections with SGLT2i included:
  • female sex (HR, 3.66; 95% CI, 3.24-4.13); and
  • history of genital infection:
    • 1-5 years (HR, 3.04; 95% CI, 2.64-3.51); and
    • >5 years (HR, 1.77; 95% CI, 1.53-2.04; P<.001 for all>
• Higher HbA1c was associated with greater infection risk in people using DPP4i, but not SGLT2i.
  • 8.0%–9.5% (64–80 mmol/mol): DPP4i- 1.12, 95% CI, 0.98-1.27; SGLT2i- 1.11, 95% CI, 0.97-1.27;
  • >9.5% (>80 mmol/mol): DPP4i- 1.48 (95% CI, 1.29-1.71); SGLT2i- 0.95 (95% CI, 0.83-1.09).
• The 1-year absolute risk of genital infection with SGLT2is was markedly increased in those with prior infection (women, 23.7%; men, 12.1%) vs. those without (women, 10.8%; men, 2.7%).
• Early genital infection was linked to an increased discontinuation risk with SGLT2i (HR, 1.48; 95% CI, 1.21-1.81) and DPP4i (HR, 1.58; 95% CI, 1.21-2.07).

Limitations

• Retrospective design.
• Inaccuracies resulting from non-coding or miscoding of genital infections.