Impact of SGLT2 inhibitors on asymptomatic bacteriuria in T2DM: prevalence, pathogens and risk factors

SGLT2 inhibitors (SGLT2i) are extensively used in India for glycemic control, weight management and cardiorenal protection in individuals with type 2 diabetes (T2DM). SGLT2i promotes glucosuria, which may predispose these patients to asymptomatic bacteriuria (ASB). In this study, we assessed the prevalence, microbial spectrum, and risk factors of ASB in T2DM patients treated with and without SGLT2i at a tertiary centre in Northern India.

This was a hospital-based, prospective observational study conducted at a tertiary care hospital in North India and included 150 adults with T2DM (75 on SGLT2i, 75 on other treatments). Midstream urine samples were collected for culture and sensitivity testing; ASB was defined as > 10⁵ CFU/mL without UTI symptoms. Microbiological analysis, antibiotic susceptibility testing, and biochemical evaluation were performed.

Total, ASB prevalence was 26.7%, and SGLT2i users had significantly higher rates than non-SGLT2i users (34.6% vs. 18.7%). Overall, Escherichia coli was the predominant organism (47.5%); non-Escherichia coli occurred exclusively in SGLT2i users (p < 0.001). SGLT2i use was independently associated with ASB in logistic regression analysis (OR 2.23, 95% CI 1.03-4.83, p = 0.043). The sensitivity to fluoroquinolones was about 45.0%, but it was 85% for Carbapenems. Age, sex, HbA1c, and eGFR were not independent predictors of ASB in regression analysis.

Occurrence of ASB is common in patients with T2DM and is significantly more common among SGLT2i users. ASB in SGLT2i user have distinct microbial spectrum. Routine urine screening may be considered in SGLT2i users, even in the absence of symptoms.