Original Abstract

AIMS: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) improve glycaemic control and cardiorenal outcomes in Type 2 diabetes, particularly in patients at elevated cardiovascular and kidney risk, yet discontinuation following infections appears common. Guidelines do not generally recommend stopping treatment after a urinary tract infection (UTI) or genital tract infection (GTI). We investigated the impact of these infections on SGLT2i discontinuation. MATERIALS AND METHODS: We conducted a population-based matched cohort study of new SGLT2i users with Type 2 diabetes in Denmark during 2016-2021. All SGLT2i users with an incident UTI or GTI episode within the first year after treatment initiation were matched 1:3 to users without a UTI/GTI by sex, age, treatment duration and calendar year. Discontinuation was defined as not filling a new prescription within 60 days after previous medication supply ended. RESULTS: Among 68 277 SGLT2i initiators, 5892 (8.6%) experienced UTI and 1389 (2%) experienced GTI during the following year. Among users with versus without UTI, discontinuation was 21.9% versus 14.3% on the date of the first expected SGLT2i refill (excess risk among users with UTI: 7.6% [95% CI 6.4%, 8.8%]), increasing to 39.5% versus 28.6% after 1 year. Among users with versus without GTI, discontinuation was 17.9% versus 15.6% (excess risk: 2.2% [95% CI -0.1%, 4.5%]) on the date of the first expected refill, rising to 43.6% versus 30.3% after 1 year. CONCLUSIONS: Patients with Type 2 diabetes who initiate SGLT2i and experience a UTI or GTI within the following year have an elevated frequency of subsequent SGLT2i discontinuation.