S1934 SGLT2 Inhibitor Use and Clinical Outcomes in Diabetic Patients With Inflammatory Bowel Disease: A Real-World Comparative Study

Introduction: Sodium–glucose co-transporter-2 inhibitors (SGLT2i) possess broad metabolic and anti-inflammatory properties that may influence the course of inflammatory bowel disease (IBD). However, their effect on clinically relevant IBD outcomes remains unclear. This study aimed to evaluate the association between SGLT2i use and key IBD-related clinical outcomes in patients with type 2 diabetes. Methods: We conducted a retrospective, propensity score–matched cohort study using the TriNetX Global Collaborative Network. Adults (≥18 years) with type 2 diabetes and IBD who initiated SGLT2 inhibitor therapy were compared to those receiving other glucose-lowering medications, including insulin. Patients who previously received IBD-related surgery were excluded from the study. Matching was conducted in a 1:1 ratio based on demographics, comorbidities, insulin use, and concurrent IBD therapies. Outcomes were assessed over a 3-year follow-up period. The primary outcomes were hospitalization requiring intravenous (IV) steroid administration and need for IBD-related surgery. Secondary outcomes included oral prednisone use and initiation of biologic therapy in biologic-naïve patients. Results: In the ulcerative colitis (UC) group (n = 2166), SGLT2i use was associated with fewer IV-steroid hospitalizations (HR 0.64, 95% CI 0.56–0.74; P < 0.001) and fewer IBD-related surgeries (HR 0.39, 0.20–0.76; P = 0.005). Oral prednisone use declined (HR 0.70, 0.63–0.78; P < 0.001), while biologic initiation was unchanged (HR 1.04, 0.77–1.40; P = 0.82). In the Crohn’s disease (CD) group (n = 1548), SGLT2i exposure produced a 61% relative reduction in IBD-related surgery (HR 0.38, 0.19–0.77; P = 0.005) without a significant effect on IV-steroid hospitalization (HR 0.88, 0.75–1.02; P = 0.09). Oral prednisone use was lower (HR 0.66, 0.59–0.75; P < 0.001), and biologic initiation remained similar between groups (HR 1.00, 0.74–1.36; P = 0.98). Conclusion: In this large real-world study, SGLT2 inhibitor therapy was linked to markedly lower surgery rates in both ulcerative colitis and Crohn’s disease and to reduced steroid requirements in UC. These findings support a potential disease-modifying role for SGLT2i in IBD and justify prospective and interventional studies.