Prevalence of genitourinary symptoms in people with type 2 diabetes initiated with SGLT2 inhibitors

Background

Sodium glucose co-transporter-2 (SGLT2) inhibitors prevent the kidneys from reabsorbing glucose from the urine. In addition to glucose-lowering effect, SGLT2 inhibitors can also reduce blood pressure and result in weight loss. In spite of the benefits of this drug, it predisposes patients to genitourinary tract infections.

Objective

This study aimed to assess the prevalence of genitourinary symptoms (GUS) in individuals with type 2 diabetes prescribed SGLT2 inhibitors and to evaluate the impact of these symptoms on treatment discontinuation.

Methods

In this cross-sectional study, a total of 320 (M:F 216:104) participants recently initiated with SGLT2 inhibitors were included from a tertiary care center for diabetes, Chennai from January to September 2022. Basic demographic, anthropometric, biochemical parameters, clinical profile, use of concomitant diabetes medications, history of GUS prior to intake of SGLT2 inhibitors, and GUS after intake of SGLT2 inhibitors were collected.

Results

The mean age of the participants was 54.5 ± 10.3 years, and the mean duration of diabetes was 12.7 ± 7.9 years. The prevalence of GUS was 18.4%. The median BMI and HbA1c were significantly high among people with GUS than without GUS (29.6 vs. 27.5 kg/m², p = 0.004) and (8.2 vs. 7.8%, p = 0.037). Among people with GUS, almost 3/4th (72.9%) were taking dapagliflozin. Around 16.9% were advised to discontinue the drug. In 18.6%, the drug was changed, and the remaining 47.5% were advised to continue the drug with precautions to drink plenty of water and maintain genital hygiene. Of those who had minimal symptoms, 10.2% were prescribed oral antifungal and antibiotics, and 6.8% were prescribed antifungal creams as the drug has several other health benefits.

Conclusion

Genitourinary symptoms were common among people with type 2 diabetes who were initiated with SGLT2 inhibitors. Prior education about the adverse events of the drug is necessary during the initiation of the treatment.