Effect of SGLT2 Inhibitors + DPP-4 Inhibitors on Urine Microbiota in Type 2 Diabetes

Area of Science:

• Microbiology
• Endocrinology
• Pharmacology

Background:

• Urogenital infections can reduce compliance with SGLT2 inhibitors in type 2 diabetes (T2D).
• Combined SGLT2 inhibitors and DPP-4 inhibitors may mitigate these side effects.
• The impact of these drug combinations on urinary microbiota is not well understood.

Purpose of the Study:

• To investigate the effects of Empagliflozin alone and in combination with Linagliptin on urinary microbiota in T2D patients.
• To compare the urinary bacterial composition between T2D patients and healthy controls.

Main Methods:

• An open-label, randomized clinical study involving 30 T2D patients and 15 healthy controls.
• Treatment duration of 12 weeks with Empagliflozin or Empagliflozin/Linagliptin.
• Urinary bacterial populations analyzed using Real-Time quantitative PCR and 16S rRNA gene sequencing.

Main Results:

• Both treatments reduced BMI; only the combination improved fasting glucose and HbA1c.
• T2D patients exhibited higher bacterial load and Bacillota abundance compared to controls, indicating urinary dysbiosis.
• Empagliflozin alone increased Bacillota and Aerococcus; the combination therapy normalized microbiota and reduced pathogens.

Conclusions:

• Combination therapy with Empagliflozin and Linagliptin may restore normal urinary microbiota composition in T2D.
• This restoration could improve patient compliance and therapeutic persistence with SGLT2 inhibitors.