Incidence and Factors Associated With Genitourinary Infections Among Type 2 Diabetes Mellitus Patients on SGLT2 Inhibitors: A Single-Center Retrospective Cohort Study

Background: The efficacy of SGLT2 inhibitors for diabetes is consistent across several studies; however, the risk of genitourinary infection due to these drugs has also been cited. Objective: To determine the incidence and factors associated with genitourinary infection among type 2 diabetes mellitus patients on SGLT2 inhibitor seen at the University of Santo Tomas Hospital Methodology: The study utilized a retrospective cohort design. Participants included 253 Type 2 diabetes mellitus patients who started SGLT2 inhibitor treatment from January 1, 2014 to June 30, 2019. Data collection via medical charts review was performed from April 1 to October 1, 2020. Multiple logistic regression analysis was performed to determine the factors associated with genitourinary infection. Stata MP version 14 software was used for data analysis. Results: The 3-month and 6-month incidence of genitourinary infection among patients treated with SGLT2 inhibitors are 2.37% and 21.78%, respectively. A significant difference in the probability of genitourinary infection across the three drugs was observed (p=0.0019). Pairwise analysis showed lower probability of infection among patients treated with canagliflozin compared to empagliflozin and dapagliflozin. Factors associated with genitourinary infection include high HbA1c at the time of treatment initiation and SUR and insulin use. The same set of factors were recorded for males. Among females, only HbA1c and eGFR at the time of SGLT2 inhibitor initiation were significantly associated with genitourinary infection. Conclusion: The study results revealed that genitourinary infection is common among patients taking SGLT2 inhibitors, especially dapagliflozin and empagliflozin. Several factors were associated with urinary and genital infection, and risk factors vary by sex. These factors include high BMI, high HbA1c levels at the time of treatment initiation, longer duration of diabetes, low eGFR, and concomitant use of insulin and/or SUR.