Urinary Tract Infections in Patients with Diabetes Mellitus Type 2 Treated with SGLT2 Inhibitors: An Evidence-Based Review

Abstract

INTRODUCTION: The mechanism of action of the sodium-glucose transporter 2 inhibitors (SGLT2i) is based on the increase of glycosuria. Current evidence shows an association between their intake and the occurrence of genital infections. However, the association with the occurrence of urinary tract infections (UTI) is not well established. We intend to analyze the evidence on the association between SGLT2i in patients with type 2 diabetes mellitus and the occurrence of UTI.
METHODS: The research comprised clinical guidelines, randomized controlled trials (RCT), meta-analysis (MA) and systematic reviews published in the National Institute for Health and Care Excellence, Cochrane Library and Pub- Med databases between October 2011 and October 2021. MeSH terms used: “urinary tract infection”, “sodium-glu- cose transporter 2 inhibitors” and “diabetes mellitus, type 2”. The Strength of Recommendation Taxonomy scale of the American Academy of Family Physicians was used for assigning evidence levels.
RESULTS: Of the 331 results, 6 met the inclusion criteria: 5 RCT and 1 MA. All were classified with level 2 of evidence. Only the MA showed a statistically significant association between the increase in UTI with the use of dapagliflozin 10 mg.
CONCLUSION: The studies show heterogenous, inconsistent and moderate quality results. SGLT2i have a major role in the treatment of many different pathologies, which is why it is imperative to carry out studies targeted to analyze the occurrence of UTI. These should comprise larger study samples, with analysis of different molecules and dosages that could contribute to a higher level of evidence.