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Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infections: a population-based study of older women and men with diabetes

Lega IC, Bronskill SE, Campitelli MA, Guan J, Stall NM, Lam K, McCarthy LM, Gruneir A, Rochon PA. Diabetes Obes Metab. 2019; Jul 2 [Epub ahead of print]. DOI: 10.1111/dom.13820.


Aims — The objective of our study was to quantify the association between SGLT2 inhibitors and each of genital mycotic infection and urinary tract infection (UTI) within 30 days of drug initiation among older women and men.

Materials and Methods — We performed a retrospective cohort study using linked administrative databases of women and men aged 66 years or older with diabetes in Ontario Canada. We compared the incidence of genital mycotic infection or UTI within 30 days between new users of a SGLT2 inhibitor and of a dipeptidyl-peptidase-4 (DPP4) inhibitor.

Results — We identified 21,444 incident SGLT2 inhibitor users and 22,463 incident DPP4 inhibitor users. Among SGLT2 inhibitor users, there were 8,848 (41%) women and the mean age at index was 71.8 ± 5 (SD) years. After adjusting for propensity score, age, sex, and recent UTI, there was a 2.47 fold increased risk of a genital mycotic infection with incident SGLT2 inhibitor use (adjusted hazard ratio (HR), 2.47; 95% confidence interval (CI) 2.08-2.92, p < 0.001) within 30 days compared to incident DPP4 inhibitor users. For UTI, the adjusted HR was 0.89 (95% CI 0.78-1.00, p=0.05).

Conclusions — Incident SGLT2 inhibitor use among older women and men is associated with an increased risk of genital mycotic infections within 30 days; there is no associated increased risk of UTI. These findings from a real-world setting provide evidence of the potential harms of SGLT2 inhibitors.

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