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Clinical Summary

Study Highlights Risk Factors of Genital Infections with SGLT2i

Takeaway

  • Prior history of genital infection and gender are key predictors of genital infection with sodium-glucose co-transporter-2 inhibitors (SGLT2i).
  • The risk of genital infection increased with higher glycated haemoglobin (HbA1c) in patients using dipeptidyl peptidase-4 inhibitor (DPP4i), but not SGLT2i.
  • Early genital infection was associated with treatment discontinuation risk.

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 year before initiation (HR, 4.47; 95% CI, 3.81-5.24);
      • 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.

McGovern AP, Hogg M, Shields BM, Sattar NA, Holman RR, Pearson ER, Hattersley AT, Jones AG, Dennis JM. Risk factors for genital infections in people initiating SGLT2 inhibitors and their impact on discontinuation. BMJ Open Diabetes Res Care. 2020;8(1). doi: 10.1136/bmjdrc-2020-001238. PMID: 32448787View full text

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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