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Association Between Sodium-Glucose Cotransporter-2 Inhibitors and Sepsis Risk in Patients With Type 2 Diabetes
Chun-Ying Wu1, Chih-Cheng Lai2,3, Chung-Han Ho4,5
1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, chimei.org.tw.
Journal of Diabetes Research
|January 12, 2026
Summary
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) significantly reduce sepsis risk in type 2 diabetes patients. This study found SGLT2i use was linked to lower rates of sepsis, septic shock, and mortality compared to DPP-4 inhibitors.
Area of Science:
- Endocrinology
- Pharmacology
- Infectious Disease Epidemiology
Background:
- Type 2 diabetes mellitus (T2DM) is a prevalent condition associated with increased infection risk.
- Sepsis poses a significant threat to patients with T2DM, necessitating effective preventative strategies.
Purpose of the Study:
- To evaluate the impact of Sodium-glucose cotransporter-2 inhibitors (SGLT2i) on the incidence of sepsis in T2DM patients.
- To compare the risk of sepsis and related complications between SGLT2i users and Dipeptidyl peptidase-4 inhibitor (DPP-4i) users.
Main Methods:
- Retrospective cohort study utilizing Taiwan's National Health Insurance Research Database (2017-2020).
- Included adult T2DM patients initiating SGLT2i or DPP-4i, matched 1:2 on age, sex, and Charlson Comorbidity Index.
- Primary outcome: sepsis. Secondary outcomes: septic shock, organ dysfunction, mortality. Analyzed using Cox proportional hazards regression.
Main Results:
- SGLT2i users exhibited a significantly lower risk of sepsis (10.1% vs. 15.5%; aHR: 0.77; 95% CI: 0.74-0.81) compared to DPP-4i users.
- Reduced risks observed for septic shock (aHR: 0.70; 95% CI: 0.57-0.87) and mortality (aHR: 0.60; 95% CI: 0.54-0.66) in SGLT2i users.
- These findings remained significant after adjusting for covariates.
Conclusions:
- SGLT2 inhibitors are associated with a substantially reduced risk of sepsis in patients with T2DM.
- The use of SGLT2i demonstrates a protective effect against sepsis, septic shock, and mortality compared to DPP-4 inhibitors.
- These results support the consideration of SGLT2i for T2DM management, particularly in infection-prone individuals.
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