Loading ...

TOPLINE:

Patients with type 2 diabetes (T2D) who initiated SGLT2 inhibitors within 3 months of a diagnosis of a urinary tract infection (UTI) had lower risks for mortality, kidney complications, and infection-related outcomes than those who initiated DPP-4 inhibitors.

METHODOLOGY:

• UTIs and acute pyelonephritis are common and serious complications in patients with T2D, and the period following these infections is associated with increased risks for systemic complications, renal decline, and cardiovascular events.
• Researchers conducted a retrospective cohort study using global health network data from 2016 to 2023 to assess whether initiating SGLT2 inhibitors vs DPP-4 inhibitors within 3 months of a UTI diagnosis is associated with improved long-term outcomes in patients with T2D.
• The analysis included propensity score-matched adults with T2D who initiated SGLT2 inhibitors (n = 2129) or DPP-4 inhibitors (n = 2129); both cohorts had a mean age of approximately 61 years and comprised 28%-29% men.
• The primary outcome was mortality; secondary outcomes included major adverse kidney events and major adverse cardiovascular events; outcomes were assessed over a 4-year period.

TAKEAWAY:

• The initiation of SGLT2 inhibitors vs DPP-4 inhibitors was associated with a 41% lower risk for mortality (hazard ratio [HR], 0.59; 95% CI, 0.45-0.77); the effect was more pronounced among women, patients younger than 65 years, those with an A1c level ≥ 7%, and those without cardiovascular or ischemic heart diseases.
• The beneficial effect of SGLT2 inhibitors on mortality outcomes started to show as early as within 6 months after diagnosing a UTI.
• The risk for major adverse kidney events (HR, 0.784; 95% CI, 0.682-0.900) was also reduced with the use of SGLT2 inhibitors vs DPP-4 inhibitors; however, no significant difference was observed for major adverse cardiovascular events.
• The risk for recurrence of UTIs was slightly lower with SGLT2 inhibitors than with DPP-4 inhibitors; the use of SGLT2 inhibitors was associated with lower risks for all-cause hospitalization, dialysis dependence, sepsis, and visits to the emergency department than the use of DPP-4 inhibitors.

IN PRACTICE:

“These findings support early post-UTI initiation of SGLT2i [SGLT2 inhibitor] as a safe and effective therapeutic option for patients with T2D,” the authors wrote.

SOURCE:

This study was led by Hsiao-Wei Wang, MD, Shin-Kong Wu Ho-Su Memorial Hospital in Taipei, Taiwan. It was published online on in Diabetes, Obesity and Metabolism.

LIMITATIONS:

Data on medication adherence, dosing, and microbiologic profiles were unavailable. The US-based sample may have limited generalizability. Individual SGLT2 inhibitor agents were not differentiated in the analysis. 

DISCLOSURES:

This study was supported by grants from Shin Kong Wu Ho-Su Memorial Hospital and Fu Jen Catholic University Hospital. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.