Frequency of urinary tract infection in patients using sodium glucose co-transporter 2 (SGLT-2) inhibitors and the effect of SGLT-2 inhibitors on renal functions

Frequency of Urinary Tract Infection in Patients Using Sodium Glucose Co-Transporter 2 (SGLT-2) Inhibitors and the Effect of SGLT-2 Inhibitors on Renal Functions Introduction and Objective: Type 2 diabetes mellitus is a growing public health problem worldwide, associated with increasing prevalence and high mortality rate. Good blood glucose control early in the disease can reduce the risk of micro- and macrovascular complications, including cardiovascular disease, diabetic nephropathy and mortality. SGLT-2 inhibitors are one of the antidiabetic agents used for this purpose. Extensive studies have been conducted on the renal effects of these drugs and the frequency of urinary infections in the literature. In this study, we aimed to investigate the frequency of urinary tract infection and its clinical and laboratory reflection on renal function in patients using SGLT-2 inhibitors. Materials and Methods: In this retrospective study, data from 195 patients with type 2 diabetes mellitus who were followed up at the Endocrinology outpatient clinic of Çukurova University Balcalı Hospital between 2018 and 2023 were reviewed. Patients were divided into two groups: those using SGLT-2 inhibitors (n=148) and those using other oral antidiabetic agents (n=47). Demographic, clinical, and biochemical data were obtained from patient records and evaluated at four time points: baseline, 3rd month, 6th month, and 12th month. A p-value of less than 0.05 was considered statistically significant. Results: While both groups demonstrated a significant reduction in glucose and HbA1c levels, the group receiving SGLT-2 inhibitors showed a significant increase in HDL levels and a significant decrease in uric acid levels (p<0.05). Although no statistically significant changes were observed in renal function parameters (creatinine and eGFR), a stable course was noted in the SGLT-2 inhibitor group. Changes in spot urine protein/creatinine (Pr/Cr) and albumin/creatinine (Alb/Cr) ratios over the follow-up period were not found to be statistically significant. During the one-year follow-up period, the incidence of genitourinary infections was 18.9% in the SGLT-2 inhibitor group, compared to 29.8% in the control group (p=0.188). Among patients using SGLT-2 inhibitors, the infection rate was significantly higher in females (47.2%) compared to males (p<0.001). No statistically significant difference was observed between the dapagliflozin and empagliflozin subgroups regarding the incidence of genitourinary infections. Conclusion: This study demonstrated that SGLT-2 inhibitors improve glycemic control and provide metabolic benefits in patients with type 2 diabetes. Although no significant deterioration was observed in renal function, further long-term studies are needed to evaluate their renal effects more clearly. Genitourinary infection risk was found to be significantly higher in female patients, which was also reflected in treatment discontinuation rates. Keywords: Real-Life Data, Renal Outcomes, SGLT-2 Inhibitors, Type 2 Diabetes Mellitus