Wound healing outcomes in diabetic kidney disease patients receiving SGLT2 inhibitor therapy: a prospective propensity score-matched cohort study
Abstract
Background The remarkable cardiorenal benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors have positioned these agents as cornerstone therapies for diabetic kidney disease (DKD). However, theoretical concerns regarding glycosuria-mediated effects on tissue perfusion have left clinicians uncertain about their safety in patients with active wounds. We conducted a prospective cohort study to characterize wound healing outcomes in this vulnerable population. Methods Between January 2018 and December 2023, we prospectively enrolled 247 adults with type 2 diabetes mellitus, estimated glomerular filtration rate (eGFR) of 30–90 mL/min/1.73m², and wounds requiring medical attention at a tertiary wound care center. Participants receiving SGLT2 inhibitors (dapagliflozin, empagliflozin, or canagliflozin) for ≥30 days were matched 1:1 with unexposed controls using propensity scores derived from 15 baseline covariates. The primary endpoint was the time to complete epithelialization; secondary endpoints included wound infection and renal progression at six months. Results Following propensity score matching, 204 patients (102 per cohort) with excellent covariate balance (all standardized mean differences <0.10) were analyzed. Wound healing trajectories were virtually identical between the cohorts: median healing time was 33 days (interquartile range [IQR]: 22–52) with SGLT2 inhibitors versus 34 days (24–62) in controls (adjusted hazard ratio [HR], 1.08; 95% confidence interval…
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: 247 participants or records.
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