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Increased HbA1c relative to actual glycemic control in patients treated with sodium-glucose cotransporter 2

Keigo Mizutani1, Eita Uenishi1,2, Takeshi Onoue1

  • 1Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Journal of Diabetes Investigation
|November 14, 2025
PubMed

Insights

Patients on sodium-glucose cotransporter 2 (SGLT2) inhibitors show higher HbA1c than glucose management indicator (GMI). This suggests SGLT2 inhibitors may overestimate glycemic control.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely used for diabetes management.
  • Glycemic control is typically assessed using HbA1c, but its accuracy may be affected by certain medications.
  • Glucose management indicator (GMI) from continuous glucose monitoring offers an alternative measure of glycemic control.

Purpose of the Study:

  • To investigate the discrepancy between HbA1c and GMI in patients with diabetes treated with SGLT2 inhibitors.
  • To compare this discrepancy with that observed in patients treated with other oral hypoglycemic agents.

Main Methods:

  • A multicenter retrospective cohort study involving 136 patients with diabetes.
  • Simultaneous measurement of HbA1c and GMI after stabilization of HbA1c levels.
  • Inverse probability of treatment weighting (IPTW) was used to adjust for confounding factors.

Main Results:

  • After IPTW adjustment, the HbA1c-GMI discrepancy was significantly higher in the SGLT2 inhibitor group (n=109) compared to the control group (n=27).
  • The difference (β = 0.42; 95% CI 0.14-0.70; P = 0.003) indicates a notable disparity.

Conclusions:

  • Patients treated with SGLT2 inhibitors may exhibit elevated HbA1c levels that do not accurately reflect their actual glycemic control.
  • This finding highlights a potential limitation of HbA1c in patients using SGLT2 inhibitors.
Abstract

Keywords:
Continuous glucose monitoringGlycated hemoglobinSodium–glucose transporter 2 inhibitor

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