Investigation of lower urinary tract symptoms and their effects on quality of life in patients using SGLT-2 (sodium-glucose cotransporter-2) inhibitors

Sodium-glucose cotransporter-2 inhibitors are oral antidiabetic agents that have gained increasing popularity in recent years for their antidiabetic effects, as well as their prominent cardio-renal and metabolic benefits in the treatment of diabetes mellitus. It is evident that their usage will further increase in the coming years, in line with the projected increase in diabetes prevalence. Our study aimed to investigate the impact of SGLT-2 inhibitors, previously limitedly discussed, on lower urinary tract symptoms and quality of life in patients with type 2 diabetes mellitus using a cross-sectional survey method. The study was conducted in the Department of Endocrinology of Başkent University Faculty of Medicine between October 2023- May 2024 on 105 diabetic patients using SGLT-2 inhibitors and 105 diabetic patients using other non-insulin antidiabetic agents. In the study, male and female patients were analysed separately by FLUTS/MLUTS questionnaires which have international and Turkish validity. In addition, additional questions were asked for data such as comorbid diseases, medication use, fluid consumption habits, and body-mass index. Independent samples t test, Mann Whitney U test, Chi-Square/Fisher's Exact test and Spearman's correlation coefficient were used in statistical analyses of comparisons between patients with and without SGLT-2 inhibitors. In the evaluations, p<0.05 was accepted as the statistical significance limit. As a result of the analyses, an increase in urinary frequency was found in male patients using SGLT-2 inhibitors (p=0,015) and no difference was found in voiding, storage and nocturia complaints compared to the group not using SGLT-2 inhibitors (p>0,05). In the analyses performed for female patients, no significant effect of SGLT-2 inhibitor use on voiding, storage and incontinence complaints was observed (p>0,05). In our study, it was revealed that the use of dapagliflozin or empagliflozin did not contribute differently to lower urinary tract symptoms for male patients, but an increase in voiding discomfort scores was observed in the group using dapagliflozin for female patients (p=0.048). Our study is the first to evaluate the contribution of SGLT-2 inhibitors to lower urinary tract symptoms separately for men and women, against a control group and holistically. It differs from most of the previous studies in that it contributed to the increase in urinary frequency in male patients and the effect was shown in drug use for more than 6 weeks. In addition, the fact that urinary frequency complaint scores were similar in male patients using SGLT-2 inhibitors before and after 1 year suggests that pollacuria probably persists in drug use for more than 1 year. The study investigated the relationship between SGLT-2 inhibitors and incontinence and provided a new perspective on the effect of SGLT-2 inhibitors on lower urinary tract symptoms with evaluations of voiding/storage phases. We believe that our study is a step to fill the gap in the literature, will contribute to rational drug use, and we hope that future studies with SGLT-2 inhibitors in larger populations will enrich our perspective on the drug class.