Incidence of Cystitis, Vaginitis, and Balanitis in United States Veterans on Sodium-Glucose Cotransporter 2 Inhibitor Therapy for Type 2 Diabetes Mellitus

Background: Sodium-glucose cotransporter 2 inhibitors are important therapies to control blood glucose levels in patients with type 2 diabetes mellitus. The mechanism by which they achieve this is through the excretion of glucose in urine, which can promote an environment for genitourinary infections. The incidence of such infections is more common in geriatric patients, which make up most of the patients in Veteran Affairs medical centers. The aim of this study is to evaluate the incidence of cystitis, vaginitis, and balanitis in Veterans on SGLT-2 therapy. Methods: We did a retrospective chart review of Veterans who received at least 6 months of SGLT-2 empagliflozin for diabetes. Indication for heart failure only was an exclusion. The study years were 2018 to 2023. Demographic data, urine cultures, and medical charts were reviewed for documentation of cystitis and clinical diagnosis of vaginitis and balanitis. Results: A total of 400 Veterans were analyzed. The median age was 74.5 years. Most of the patients were men. There were 43 (10.75%) occasions of infectious complications: 32 cystitis, 6 balanitis, and 5 fungal vaginitis. There were no multidrug-resistant organisms isolated. There were no differences in the 2 groups (infectious complications versus noninfectious) in terms of age, hemoglobin A1C, body mass index, or duration of treatment. However, benign prostatic hyperplasia was more common in the infectious group. Conclusions: The incidence of infectious complications in our diabetic Veterans was minimal in number, with cystitis being at 8% and observed more in men with prostatomegaly. E. coli was the most frequent isolate in urine cultures. Isolation of multidrug-resistant organisms was not observed.