Tolerability of Sodium-Glucose Co-transporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an emerging treatment for type 2 diabetes mellitus (T2DM). The effect and tolerability of SGLT2 inhibitors in patients with T2DM, especially related risk factors and susceptible populations, are an area of ongoing research. Aim The aim of this study was to evaluate the tolerability of SGLT2 inhibitors, particularly the risk associated with urogenital infection, in patients with T2DM. Methods This retrospective cohort study included 275 participants (median age: 64 years). Electronic medical records of patients with T2DM who underwent treatment with approved SGLT2 inhibitors between January 2020 and December 2022 at our institute were reviewed. Multiple variables were used to assess the tolerability of SGLT2 inhibitors and factors associated with genitourinary infections. Results The incidence of genitourinary infections was 13.1% among patients with T2DM taking SGLT2 inhibitors, which was lower than the reported national and global incidences of urinary tract infections (UTIs) among patients with diabetes. Patients with a history of UTIs were more likely to develop recurrent infections (hazard ratio [HR], 3.32; 95% confidence interval [CI]: 1.56, 7.09). A higher pretreatment glomerular filtration rate was associated with a lower risk of UTIs (HR, 0.98; 95% CI: 0.97, 0.99). Conclusions SGLT2 inhibitor administration in patients with T2DM does not significantly increase the risk of UTIs compared with the reported national and global rates of UTIs among patients with diabetes. Variable hygiene practices among the Muslim community may be a possible explanation for the observed differences in the rates of UTIs.