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SGLT2 Inhibitors and Mortality in Endometriosis With Type 2 Diabetes: A Propensity-Matched Analysis
Benjamin Marchandot1, Olivier Morel2, Mickael Guglieri3
1Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France; Research Unit-UR3074, Translational Cardiovascular Medicine, University of Strasbourg, Strasbourg, France; GERCA, Groupe pour l'Enseignement et la Recherche Cardiovasculaire en Alsace, Strasbourg, France.
JACC. Advances
|April 2, 2026
Summary
Adding sodium glucose co-transporter 2 inhibitors (SGLT2i) to metformin therapy in patients with endometriosis and type 2 diabetes significantly lowered mortality. Cardiovascular outcomes were similar, but kidney disease progression was numerically higher with SGLT2i.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Endometriosis is an inflammatory condition linked to cardiovascular risks.
- Glucose-lowering drug selection for patients with endometriosis and type 2 diabetes lacks evidence-based guidance.
Purpose of the Study:
- To compare mortality, cardiovascular events, and renal outcomes in adults with endometriosis and type 2 diabetes (T2D).
- To evaluate sodium glucose co-transporter 2 inhibitors (SGLT2i) added to metformin versus metformin alone.
Main Methods:
- Retrospective cohort study utilizing routinely collected health data.
- 1:1 propensity score matching created two groups of 3,072 patients each.
- Time-to-event analysis reported hazard ratios (HRs) with 95% confidence intervals (CIs).
Main Results:
- All-cause mortality was significantly lower in the SGLT2i plus metformin group (HR: 0.52; P < 0.0001).
- No significant differences were observed in major cardiovascular events like stroke, myocardial infarction, or heart failure.
- Progression to advanced chronic kidney disease (stage 4-5) was numerically higher with SGLT2i (HR: 1.28; P = 0.05).
Conclusions:
- SGLT2 inhibitors added to metformin therapy reduced mortality in patients with endometriosis and T2D.
- Most cardiovascular outcomes did not differ significantly between treatment groups.
- Further research is needed regarding renal endpoints in this population.
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