Association of SGLT2 Inhibitor Use with Glycosuria, Pyuria, Urinary Symptoms, and Significant Urine Culture Positivity in Adults with Type 2 Diabetes: A Prospective Cross-Sectional Study
Abstract
Background and Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors increase urinary glucose excretion, but the relationship between glycosuria and findings supporting urinary tract infection (UTI) remains unclear. We evaluated associations of SGLT2 inhibitor use with glycosuria, pyuria, UTI-compatible symptoms, and significant urine culture positivity in adults with type 2 diabetes. Materials and Methods: This prospective cross-sectional study included 251 adults who reported using every agent in their current oral antidiabetic regimen for at least three months. Blood tests, urinalysis, and midstream urine culture were obtained at a single study visit. SGLT2 inhibitor users and nonusers were compared; contaminated cultures were excluded from culture-based analyses. Multivariable logistic regression examined factors associated with glycosuria and pyuria. Results: Overall, 108 participants (43.0%) used an SGLT2 inhibitor (dapagliflozin, n = 51; empagliflozin, n = 57). Glycosuria was more frequent among users than nonusers (69.4% vs. 39.9%; OR = 3.43; 95% CI, 2.02-5.82; p < 0.001). In multivariable analysis, SGLT2 inhibitor use (adjusted OR = 3.14; 95% CI, 1.75-5.63) and each 1% increase in HbA1c (adjusted OR = 1.56; 95% CI, 1.27-1.92) were independently associated with glycosuria. Pyuria and UTI-compatible symptoms did not differ between groups. Among 217 evaluable cultures, significant culture positivity was numerically higher among users, but the estimate was…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 251 participants or records.
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