SGLT2 Inhibitors and External Genital Infection in Male Patients With Type 2 Diabetes.

Area of Science:

• Endocrinology
• Pharmacology
• Infectious Disease

Background:

• Newer type 2 diabetes (T2D) medications like SGLT2 inhibitors (SGLT2Is) and GLP-1 receptor agonists (GLP-1RAs) offer improved glycemic control.
• The US FDA has issued warnings regarding potential risks of Fournier gangrene, a severe genital infection, associated with SGLT2I use.

Purpose of the Study:

• To determine the comparative risks of male external genital infections (MEGIs) in adult male patients with T2D treated with SGLT2Is versus GLP-1RAs.
• To evaluate the association between SGLT2I use and the incidence of MEGIs in a real-world setting.

Main Methods:

• A population-based cohort study utilizing Taiwan's National Health Insurance Research Database.
• Adult male patients with T2D newly treated with SGLT2Is (2009-2020) were compared with those treated with GLP-1RAs.
• Propensity score weighting was used to balance baseline characteristics between treatment groups.

Main Results:

• The SGLT2I group showed a significantly increased risk of MEGI compared to the GLP-1RA group (HR, 1.65; 95% CI, 1.59-1.71).
• Subgroup analyses revealed a higher MEGI risk with SGLT2Is in patients younger than 60 years, with moderate kidney dysfunction (eGFR 60 mL/min/1.73 m2), and with well-controlled diabetes (HbA1c <7%).

Conclusions:

• SGLT2 inhibitors are associated with an elevated risk of male external genital infections in adult male patients with type 2 diabetes when compared to GLP-1 receptor agonists.
• Healthcare providers should consider this increased risk and exercise caution when prescribing SGLT2Is to male patients with T2D.