Therapeutic potential of SGLT-2 inhibitors and DDP4 inhibitors in elderly patients with type 2 diabetes mellitus and benign prostatic hyperplasia

Background. Benign prostatic hyperplasia (BPH) has recently been linked to diabetes mellitus and insulin resistance. This study aims to explore whether the use of either sodium-glucose co-transporter-2 (SGLT-2) inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors is associated with favorable outcomes in prostate volume and symptoms. Methods. This is a before-and-after study involving 57 elderly male patients with type 2 diabetes mellitus and BPH, who were recruited and followed up for one year. Twenty-seven patients were prescribed SGLT-2 inhibitors (Dapagliflozin 10 mg), and thirty patients were prescribed DPP-4 inhibitors (Sitagliptin 100 mg). Prostate volume, International Prostate Symptom Score (IPSS), and Pittsburgh Sleep Quality Index (PSQI) were assessed in all patients. Results. The use of either SGLT-2 inhibitors or DPP-4 inhibitors was associated with a statistically significant decrease in prostate volume after one year of treatment (p = 0.04 for SGLT-2 inhibitors and p = 0.02 for DPP-4 inhibitors). Statistically significant reductions were found in both groups regarding post-voiding urine volume after one year of treatment compared to baseline levels (p = 0.014 for SGLT-2 inhibitors and p = 0.017 for DPP-4 inhibitors). At the end of the follow-up period, there was a statistically significant reduction in IPSS scores (p = 0.02 for SGLT-2 inhibitors and p = 0.03 for DPP-4 inhibitors). Similarly, the use of either DPP-4 inhibitors or SGLT-2 inhibitors was associated with a statistically significant improvement in nocturia and sleep quality (PSQI score) (p = 0.012 for SGLT-2 inhibitors and p = 0.01 for DPP-4 inhibitors). Post-hoc analysis showed that DPP-4 inhibitors were superior to SGLT-2 inhibitors in reducing prostate volume and symptoms (p < 0.05). Conclusion. Both SGLT-2 inhibitors and DPP-4 inhibitors improve prostate volume and symptoms in patients with diabetes mellitus and BPH. Notably, DPP-4 inhibitors exhibited superiority over SGLT-2 inhibitors in terms of reducing prostate volume and alleviating symptoms. Larger-scale studies are required to confirm these favorable effects.