TOPLINE:

Among patients with type 2 diabetes (T2D), SGLT2 inhibitor therapy was associated with a lower incidence of iron deficiency anaemia than DPP-4 inhibitor therapy. This benefit was most pronounced in men, patients aged 61 years or older, and patients with shorter durations of metformin use.

METHODOLOGY:

• Researchers in Germany conducted a retrospective cohort study to assess whether SGLT2 inhibitor use is linked to a lower incidence of iron deficiency anaemia in patients with T2D.
• They analysed 28,441 patients (mean age, 64.3 years; 36.5% women) who initiated SGLT2 inhibitor therapy between 2012 and 2022 and compared them with propensity score-matched patients who began DPP-4 inhibitor therapy during the same period; all participants were on concurrent metformin therapy.
• Patients were followed up for up to 5 years, with follow-up ending at the first diagnosis of iron deficiency anaemia, a change in antihyperglycemic therapy, loss to follow-up, or the end of the study period, whichever occurred first.
• The study outcome was the cumulative incidence of iron deficiency anaemia in each treatment group.

TAKEAWAY:

• The 5-year cumulative incidence of iron deficiency anaemia was significantly lower in the SGLT2 inhibitor cohort than in the DPP-4 inhibitor cohort (6.9% vs 11.3%; P < .001).
• SGLT2 inhibitor therapy was associated with a 33% decreased risk for iron deficiency anaemia compared with DPP-4 inhibitor therapy (hazard ratio [HR], 0.67; P < .001).
• In subgroup analyses, the protective effect of SGLT2 inhibitors was significant in all patients aged 61 years or older and was more prominent in men, especially those aged 51-70 years, than in women.
• When stratified by metformin duration, the benefit of SGLT2 inhibitors emerged only among patients with a shorter duration of metformin use (< 1 year and < 3 years).

IN PRACTICE:

"These data underscore the potential benefits of SGLT2 inhibitors beyond glycaemic control, suggesting a favourable effect on iron homeostasis, especially in selected patient subgroups," the authors wrote.

SOURCE:

The study was led by Theresia Sarabhai, MD, Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany. It was published online on August 22, 2025, in Diabetes, Obesity and Metabolism.

LIMITATIONS:

The observational design precluded any causal inference. Data on socioeconomic status were not collected. The lack of laboratory confirmation for iron deficiency anaemia may have led to underdiagnosis or misclassification. Additionally, the study did not account for over-the-counter supplementation for iron, vitamin B12, or folate.

DISCLOSURES:

The research received no specific funding from public, commercial, or nonprofit organizations. One author received support through the DFG Clinician Scientist Programme at UMEA. The authors reported having 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.