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Discontinuation of SGLT2i After a Urogenital Infection: A Population-Based Matched Cohort Study of Patients With Type
Christine Ljungberg1, Mette Nørgaard1, Christina Vandenbroucke-Grauls1,2
1Department of Clinical Epidemiology and Center for Population Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Aims:
Sodium-glucose cotransporter 2 inhibitors (SGLT2is) improve glycaemic control and cardiorenal outcomes in Type 2 diabetes, particularly in patients at elevated cardiovascular and kidney risk, yet discontinuation following infections appears common. Guidelines do not generally recommend stopping treatment after a urinary tract infection (UTI) or genital tract infection (GTI). We investigated the impact of these infections on SGLT2i discontinuation.
Materials And Methods:
We conducted a population-based matched cohort study of new SGLT2i users with Type 2 diabetes in Denmark during 2016-2021. All SGLT2i users with an incident UTI or GTI episode within the first year after treatment initiation were matched 1:3 to users without a UTI/GTI by sex, age, treatment duration and calendar year. Discontinuation was defined as not filling a new prescription within 60 days after previous medication supply ended.
Results:
Among 68 277 SGLT2i initiators, 5892 (8.6%) experienced UTI and 1389 (2%) experienced GTI during the following year. Among users with versus without UTI, discontinuation was 21.9% versus 14.3% on the date of the first expected SGLT2i refill (excess risk among users with UTI: 7.6% [95% CI 6.4%, 8.8%]), increasing to 39.5% versus 28.6% after 1 year. Among users with versus without GTI, discontinuation was 17.9% versus 15.6% (excess risk: 2.2% [95% CI -0.1%, 4.5%]) on the date of the first expected refill, rising to 43.6% versus 30.3% after 1 year.
Conclusions:
Patients with Type 2 diabetes who initiate SGLT2i and experience a UTI or GTI within the following year have an elevated frequency of subsequent SGLT2i discontinuation.
Insights
Urinary tract infections (UTIs) and genital tract infections (GTIs) in patients with Type 2 diabetes are linked to higher rates of discontinuing sodium-glucose cotransporter 2 inhibitors (SGLT2is). This suggests infections may impact long-term SGLT2i treatment adherence.
Area of Science:
- Endocrinology
- Pharmacology
- Public Health
Background:
- Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are crucial for managing Type 2 diabetes, offering benefits beyond glycemic control, including cardiorenal protection.
- Despite established benefits, SGLT2i discontinuation is a concern, particularly following common infections like urinary tract infections (UTIs) and genital tract infections (GTIs).
Purpose of the Study:
- To investigate the association between incident UTIs or GTIs and the subsequent discontinuation of SGLT2 inhibitors in patients with Type 2 diabetes.
- To quantify the impact of these infections on SGLT2i treatment adherence.
Main Methods:
- A population-based matched cohort study was conducted in Denmark (2016-2021) involving new users of SGLT2is with Type 2 diabetes.
- Patients experiencing a UTI or GTI within the first year of SGLT2i initiation were matched 1:3 to control patients without these infections.
- Discontinuation was defined as a gap of 60 days or more in prescription refills.
Main Results:
- A significant proportion of SGLT2i users experienced UTIs (8.6%) or GTIs (2%) within the first year.
- Patients with a UTI showed a higher discontinuation rate (21.9% vs. 14.3% at first refill, 39.5% vs. 28.6% after 1 year) compared to those without.
- Patients with a GTI also had increased discontinuation rates (17.9% vs. 15.6% at first refill, 43.6% vs. 30.3% after 1 year).
Conclusions:
- Experiencing a UTI or GTI following SGLT2i initiation is associated with a notable increase in subsequent treatment discontinuation.
- These findings highlight a potential barrier to sustained SGLT2i therapy and suggest a need for strategies to support treatment adherence post-infection.
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