Prevalence of Genital Mycotic Infections with Sodium-Glucose Co-Transporter 2 Inhibitors among Type 2 Diabetic Patients

Sohail Aslam; Qaisar Mehmood; Nadeem Naeem; Dial Das; Qasim Zafar; Hafsa Jamil

doi:10.70749/ijbr.v3i5.1468

Authors

Sohail Aslam Department of Endocrinology, Services Hospital, Lahore, Pakistan
Qaisar Mehmood Department of Medicine and Medical ICU, Shaikh Zayed Hospital, Lahore, Pakistan
Nadeem Naeem Department of Endocrinology, Memon Medical Institute Hospital, Karachi, Pakistan
Dial Das Department of Pharmacology, Chandka Medical College, Larkana, Pakistan
Qasim Zafar Iqra Welfare Trust Mirpur, AJK
Hafsa Jamil MCH & EPI Centre ADHO Office Dadyal, AJK

DOI:

https://doi.org/10.70749/ijbr.v3i5.1468

Keywords:

Genital Mycotic Infections, Type 2 Diabetes Mellitus, Prevalence, SGLT2i

Abstract

Background and Aim: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as an effective oral antidiabetic agents for glycemic control in patients with type 2 diabetes mellitus (T2DM). However, the mechanism of their action - promoting glycosuria - is associated with increasing risk of genital mycotic infections. The purpose of this study was to determine the prevalence of genital mycotic infections among T2DM patients using SGLT2 inhibitors. Patients and Method: A cross-sectional observational study investigated 300 T2DM patients receiving SGLT2 inhibitors in the Diabetes Management Center of Services Hospital, Lahore during January 16, 2025 to April 15, 2025. Clinical data, including the type and duration of demographic characteristics, SGLT2 inhibitors therapy, collected through structured interviews and medical records to the history of clinical data, HBA1C level, personal hygiene practices, and genital infections. The diagnosis of genital mycotic infection based on clinical symptoms and confirmed by laboratory findings where necessary. SPSS version 26 used for data analysis. Results: Of the 300 patients, 78 (26%) developed genital mycotic infections. The prevalence in women was much higher (38%) than men (17%) (p <0.01). Poor glycemic control (HBA1C> 8%) and inadequate hygiene important risk factor were found (P <0.05). The highest prevalence of was seen within the first 6 months of initiating SGLT2 inhibitor therapy, especially with dapagliflozin. 12 patients had recurrent infections, and most cases responded well to antifungal therapy without discontinuation of SGLT 2 obstructions.Conclusion: Genital mycotic infections have common but manageable side effects of SGLT2 inhibitors in T2DM patients, especially in women and those with poor glycemic control. Early patient’s education on genital hygiene and close monitoring can reduce the incidence and improve treatment adherence during the initial months of therapy.

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References

Lega IC, Bronskill SE, Campitelli MA, et al. Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: A population-based study of older women and men with diabetes. Diabetes Obes Metab. 2019;21:2394–2404.

https://doi.org/10.1111/dom.13820.

Fadini GP, Bonora BM, Mayur S, Rigato M, Avogaro A. Dipeptidyl peptidase-4 inhibitors moderate the risk of genitourinary tract infections associated with sodium-glucose co-transporter-2 inhibitors. Diabetes Obes Metab. 2018;20:740-744.

https://doi.org/10.1111/dom.13130

Nichols GA, Brodovicz KG, Kimes TM, Deruaz-Luyet A, Bartels DB. Prevalence and incidence of urinary tract and genital infections among patients with and without type 2 diabetes. J Diabetes Complications. 2017;31:1587-1591.

https://doi.org/10.1016/j.jdiacomp.2017.07.018

Burke KR, Schumacher CA, Harpe SE. SGLT2 inhibitors: a systematic review of diabetic ketoacidosis and related risk factors in the primary literature. Pharmacotherapy. 2017;37:187-194.

https://doi.org/10.1002/phar.1881

Chang HY, Singh S, Mansour O, Baksh S, Alexander GC. Association between sodium-glucose cotransporter 2 inhibitors and lower extremity amputation among patients with type 2 diabetes. JAMA Intern Med. 2018;178:1190-1198.

https://doi.org/10.1001/jamainternmed.2018.3034

Perlman A, Heyman SN, Matok I, Stokar J, Muszkat M, Szalat A. Acute renal failure with sodium-glucose-cotransporter-2 inhibitors: analysis of the FDA adverse event report system database. Nutr Metab Cardiovasc Dis. 2017;27:1108-1113.

https://doi.org/10.1016/j.numecd.2017.10.011

Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital infections with sodium glucose cotransporter‑2 inhibitors: Occurrence and management in patients with Type 2 diabetes mellitus. Indian J Endocr Metab 2018;22:837‑42.

https://doi.org/10.4103/ijem.ijem_159_17

Amin R, Ali Y, Idrees S, Ashraf AB, Safeer B, Manzoor A. The role of combination therapies in optimizing diabetes management. Indus Journal of Bioscience Research. 2024 Nov 26;2(02):582-8.

https://doi.org/10.70749/ijbr.v2i02.244

Engelhardt K, Ferguson M, Rosselli JL. Prevention and management of genital mycotic infections in the setting of sodium-glucose cotransporter 2 inhibitors. Annals of Pharmacotherapy. 2021 ;55(4):543-8.

https://doi.org/10.1177/1060028020951928

Shrikrishna A, Archana B. Prevalence of genitourinary infection in diabetic patients treated with SGLT 2 inhibitors. African Health Sciences. 2023 6;23(1):270-5.

https://doi.org/10.4314/ahs.v23i1.29

Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital infections with sodium glucose cotransporter-2 inhibitors: occurrence and management in patients with type 2 diabetes mellitus. Indian journal of endocrinology and metabolism. 2018 1;22(6):837-42.

Adimadhyam S, Schumock GT, Calip GS, Smith Marsh DE, Layden BT, Lee TA. Increased risk of mycotic infections associated with sodium–glucose co‐transporter 2 inhibitors: a prescription sequence symmetry analysis. British Journal of Clinical Pharmacology. 2019 ;85(1):160-8.

https://doi.org/10.1111/bcp.13782

Zulfiqar R, Abbas K, Khan S, Fatima K, Manzoor A, Awais M. Long-term benefits of continuous glucose monitoring combined with insulin pump therapy. Indus Journal of Bioscience Research. 2024 Dec 4;2(02):785-91.

https://doi.org/10.70749/ijbr.v2i02.264

Puckrin R, Saltiel MP, Reynier P, Azoulay L, Yu OHY, Filion KB. SGLT-2 inhibitors and the risk of infections: a systematic review and meta-analysis of randomized controlled trials. Acta Diabetol. 2018;55:503-514.

https://doi.org/10.1007/s00592-018-1116-0

Thong KY, Yadagiri M, Barnes DJ, et al; ABCD Nationwide Dapagliflozin Audit Contributors. Clinical risk factors predicting genital fungal infections with sodium-glucose cotransporter 2 inhibitor treatment: the ABCD nationwide dapagliflozin audit. Prim Care Diabetes. 2018;12:45-50.

https://doi.org/10.1016/j.pcd.2017.06.004

Williams SM, Ahmed SH. Improving compliance with SGLT2 inhibitors by reducing the risk of genital mycotic infections: the outcomes of personal hygiene advice. Diabetes. 2019;68(suppl 1):1224-P.

https://doi.org/10.2337/db19-1224-p

Liu J, Li L, Li S, et al. Effects of SGLT2 inhibitors on UTIs and genital infections in type 2 diabetes mellitus: a systematic review and meta-analysis. Sci Rep 2017; 7: 2824.

https://doi.org/10.1038/s41598-017-02733-w

Nakhleh A, Zloczower M, Gabay L, Shehadeh N. Effects of sodium glucose co-transporter 2 inhibitors on genital infections in female patients with type 2 diabetes mellitus–Real world data analysis. Journal of Diabetes and its Complications. 2020 1;34(7):107587.

https://doi.org/10.1016/j.jdiacomp.2020.107587

Varshney N, Billups SJ, Saseen JJ, Fixen CW. Sodium-glucose cotransporter-2 inhibitors and risk for genitourinary infections in older adults with type 2 diabetes. Therapeutic Advances in Drug Safety. 2021; 12:2042098621997703.

https://doi.org/10.1177/2042098621997703

Udell JA, Yuan Z, Rush T, et al. Cardiovascular outcomes and risks after initiation of a sodium glucose cotransporter 2 inhibitor: results from the EASEL population-based cohort study (evidence for cardiovascular outcomes with sodium glucose cotransporter 2 inhibitors in the real world). Circulation 2018; 137: 1450–1459.

https://doi.org/10.1161/circulationaha.117.031227

Dave CV, Schneeweiss S, Kim D, et al. Sodium-glucose cotransporter-2 inhibitors and the risk for severe urinary tract infections: a population-based cohort study. Ann Intern Med 2019; 171: 248–256.

https://doi.org/10.7326/m18-3136

Li D, Wang T, Shen S, Fang Z, Dong Y, Tang H. Urinary tract and genital infections in patients with type 2 diabetes treated with sodium-glucose co-transporter 2 inhibitors: a meta-analysis of randomized controlled trials. Diabetes Obes Metab 2017; 19: 348–355.

https://doi.org/10.1111/dom.12825