Sodium-Glucose Cotransporter 2 Inhibitors, Erythrocytosis, and Thrombosis in Adults With Type 2 Diabetes
Abstract
IMPORTANCE: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are widely used and have been shown to induce erythrocytosis. However, the clinical implications of this phenomenon, particularly its association with venous and arterial thrombotic events, remain uncertain.
OBJECTIVE: To assess the extent, temporal course, and thrombotic complications of SGLT2i-induced erythrocytosis.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used patient data from Israel's largest health care organization from January 1, 2015, through June 30, 2024. Adult patients aged 18 years or older with type 2 diabetes who initiated SGLT2is were identified and compared with those who initiated dipeptidyl peptidase 4 inhibitors (DPP-4is) or glucagon-like peptide 1 receptor agonists (GLP-1RAs) using a propensity score-matched, active-comparator, new-user cohort design.
EXPOSURE: New initiation of an SGLT2i, a GLP-1RA, or a DPP-4i.
MAIN OUTCOMES AND MEASURES: Outcomes included erythrocytosis within 1 year of initiating SGLT2is, as well as arterial and venous thrombotic events until the end of follow-up. Prevalence rates, rate differences, and odds ratios (ORs) for new-onset erythrocytosis and hemoglobin increase greater than 0.5 g/dL with 95% CIs were calculated. Hazard ratios (HRs) and 95% CIs for thrombotic outcomes were estimated using time-varying Cox proportional hazards regression models.
RESULTS: After 1:1 propensity score matching, a total of 137 552 adults were included in…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 137 participants or records.
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