TOPLINE

Among patients with type 2 diabetes (T2D) who initiated SGLT2 inhibitor therapy, those who developed a urinary tract infection (UTI) or genital tract infection (GTI) within the first year were significantly more likely to discontinue SGLT2 treatment than matched patients without an infection.

METHODOLOGY

• Although current guidelines do not list UTIs or GTIs as reasons to stop SGLT2 inhibitor therapy, many patients still stop treatment in routine practice, potentially undermining its long-term heart and kidney benefits.
• To investigate this issue, researchers conducted a population-based cohort study in Denmark, including 68,277 patients with T2D who were new users of SGLT2 inhibitors and had received metformin previously.
• Patients with a first episode of UTI (n = 5892; median age, 69 years; 62.9% women) or GTI (n = 1389; median age, 62 years; 73.5% women) within one year of starting SGLT2 treatment were matched with patients without the corresponding infection based on sex, age, duration of SGLT2 inhibitor use, and year of initiation.
• UTIs or GTIs were identified through hospital diagnosis or filled prescriptions for specific drugs (sulfamethizole, trimethoprim, pivmecillinam, or nitrofurantoin for UTIs and clotrimazole for GTIs).
• Discontinuation was defined as a treatment gap of at least 60 days after the estimated end of prior supply; follow-up for discontinuation began at the first expected refill date (end of the ongoing prescription plus a 60‑day grace period).

TAKEAWAY

• On the date of the first expected refill, patients with vs without a UTI were 53% more likely to discontinue SGLT2 inhibitor treatment (21.9% vs 14.3%; risk ratio [RR], 1.53; 95% CI, 1.43-1.64).
• At 1 year of follow-up, the rates of discontinuation reached 39.5% among patients with a UTI compared with 28.6% among those without, reflecting a 38% higher risk (RR, 1.38; 95% CI, 1.31-1.45).
• For patients with a GTI, the difference on the expected refill date was small and not statistically significant; at 1 year, the rate of discontinuation increased to 43.6% among those with a GTI compared wth 30.3% among those without a GTI (RR, 1.44; 95% CI, 1.30-1.58).

IN PRACTICE

“Together, these findings highlight the need to support clinicians in distinguishing between situations that warrant treatment interruption and those in which [SGLT2 inhibitors] can safely be continued to avoid unnecessary loss of long-term benefits,” the authors wrote. 

SOURCE

The study was led by Christine Ljungberg, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. It was published online in Diabetes, Obesity and Metabolism.

LIMITATIONS

The study relied on diagnostic codes and prescription data, which may have led to the misclassification of cases. UTIs treated with broader-spectrum or nonspecific antibiotics and GTIs managed with over-the-counter clotrimazole or other topical agents were missed. The exact date of discontinuation could not be determined, and the cohort was limited to patients who had previously used metformin.

DISCLOSURES

This study was funded by Aarhus University. One author disclosed giving presentations and lectures on medical research for pharmaceutical companies including AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Sanofi, with and without financial compensation.

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