Wen Yuan-Liang, Hsu Wan-Ting, Chen Yi-Hsien, Kao Hui-Han, Liao Chun-Cheng, To Sheng-Yin, Yang Hui-Wen, Kao Li-Ting
School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
Br J Dermatol. 2025 Jun 20;193(1):74-84. doi: 10.1093/bjd/ljaf086.
Sodium-glucose cotransporter-2 inhibitors (SGLT2i), a novel class of antidiabetic medication, have emerged as a key treatment option in diabetes management. Notably, SGLT2i promote glucose and sodium excretion through urine, a mechanism that may be implicated in the potential association between SGLT2i use and risk of atopic dermatitis (AD).
To investigate the relationship between SGLT2i use and new-onset AD in people with diabetes.
This nationwide active-comparator cohort study used data from the Taiwan National Health Insurance database to investigate the association between SGLT2i use and AD risk. The study included adults with type 2 diabetes mellitus who initiated SGLT2i or DPP4i between May 2016 and December 2018, with no prescriptions for other SGLT2i or DPP4i in the 12 months prior to cohort entry. A total of 148 354 SGLT2i users were identified as the study group, while 322 703 DPP4i users were designated as the active comparator group. The primary outcome was the incidence of AD. To minimize potential confounding, inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics, medical history and ever having used medication between the two groups. Additionally, sensitivity analyses, subgroup analyses and sex-specific assessments were conducted to further validate the findings. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of developing AD.
SGLT2i users had a lower incidence of AD (9.742 vs. 12.070 per 1000 PY) than DPP4i users. SGLT2i users had a significantly lower risk of AD compared with DPP4i users (HR 0.847) after IPTW adjustment. Different types of SGLT2i also showed a consistent protective effect for AD. Notably, the highest SGLT2i dosage was associated with the lowest risk of AD (IPTW-adjusted HR 0.647), consistent across sensitivity analyses. Additionally, men who use SGLT2i exhibited a much lower risk of AD (IPTW-adjusted HR 0.750) than women who use SGLT2i.
SGLT2i show a significant protective effect against AD in patients with diabetes compared with DPP4i. This robust finding, consistent across weighting and sensitivity analyses, supports SGLT2i use, with a strong protective effect also found in the dose-response analysis.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是一类新型抗糖尿病药物，已成为糖尿病管理的关键治疗选择。值得注意的是，SGLT2i可促进葡萄糖和钠通过尿液排泄，这一机制可能与SGLT2i使用与特应性皮炎（AD）风险之间的潜在关联有关。
研究糖尿病患者使用SGLT2i与新发AD之间的关系。
这项全国性的活性对照队列研究使用了台湾国民健康保险数据库的数据，以调查SGLT2i使用与AD风险之间的关联。该研究纳入了2016年5月至2018年12月期间开始使用SGLT2i或二肽基肽酶4抑制剂（DPP4i）的2型糖尿病成年患者，在队列入组前12个月内没有其他SGLT2i或DPP4i的处方。共确定148354名SGLT2i使用者为研究组，而322703名DPP4i使用者被指定为活性对照组。主要结局是AD的发病率。为了尽量减少潜在的混杂因素，采用治疗权重逆概率（IPTW）来平衡两组之间的基线特征、病史和既往用药情况。此外，还进行了敏感性分析、亚组分析和性别特异性评估，以进一步验证研究结果。采用Cox比例风险回归模型来估计发生AD风险的风险比（HR）和95%置信区间（CI）。
SGLT2i使用者的AD发病率（每1000人年9.742例 vs. 12.070例）低于DPP4i使用者。IPTW调整后，与DPP4i使用者相比，SGLT2i使用者发生AD的风险显著更低（HR 0.847）。不同类型的SGLT2i对AD也显示出一致的保护作用。值得注意的是，SGLT2i最高剂量与最低的AD风险相关（IPTW调整后的HR 0.647），在敏感性分析中保持一致。此外，使用SGLT2i的男性发生AD的风险（IPTW调整后的HR 0.750）远低于使用SGLT2i的女性。
与DPP4i相比，SGLT2i对糖尿病患者的AD具有显著的保护作用。这一有力的发现，在加权和敏感性分析中保持一致，支持使用SGLT2i，剂量反应分析中也发现了很强的保护作用。
