Study highlights risk factors of genital infections with SGLT2i

  • McGovern AP & al.
  • BMJ Open Diabetes Res Care
  • 1 May 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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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:
      • 1-5 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.