Wu Du-An, Hsu Bang-Gee, Lin Yu-Li
Division of Metabolism and Endocrinology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2025 Apr 4;37(3):255-263. doi: 10.4103/tcmj.tcmj_275_24. eCollection 2025 Jul-Sep.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors have convincingly demonstrated efficacy in reducing cardiovascular (CV) and renal complications in patients with diabetes mellitus, chronic kidney disease, and heart failure. However, their use is also linked to the concern of some adverse events, the most common being genital and urinary tract infections (UTIs). This review summarizes the risks of genital and UTIs of SGLT2 inhibitors across large-scale clinical trials, meta-analyses, and real-world cohort studies. SGLT2 inhibitors are shown to significantly increase the risk of genital infections in clinical trials and real-world observational studies and marginally increase the risk of UTI in meta-analyses. We also discuss the potential pathogenesis of SGLT2 inhibitor-related infections and identify the susceptible risk factors. Since most genital and UTIs associated with SGLT2 inhibitors are mild and treatable and severe infections are rare, the use of SGLT2 inhibitors is highly recommended in patients who meet the inclusion criteria of clinical trials, where the CV and renal benefits outweigh the infection risks. For all users of SGLT2 inhibitors, preventive strategies, patient education, and careful monitoring are essential to minimize the infection risks. Furthermore, we address an unmet need regarding SGLT2 inhibitors among vulnerable populations, such as older adults, frail, and immunocompromised patients, underscoring the importance of observational studies from the real-world data. Future research should focus on identifying the high-risk groups, developing SGLT2 inhibitors with a lower infection profile and establishing effective prevention strategies to mitigate the risk of genital and UTIs associated with these medications.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已令人信服地证明在降低糖尿病、慢性肾脏病和心力衰竭患者的心血管（CV）和肾脏并发症方面具有疗效。然而，其使用也与一些不良事件相关，最常见的是生殖器和尿路感染（UTI）。本综述总结了SGLT2抑制剂在大规模临床试验、荟萃分析和真实世界队列研究中导致生殖器和UTI的风险。在临床试验和真实世界观察性研究中，SGLT2抑制剂显示会显著增加生殖器感染风险，在荟萃分析中会略微增加UTI风险。我们还讨论了SGLT2抑制剂相关感染的潜在发病机制，并确定了易感风险因素。由于大多数与SGLT2抑制剂相关的生殖器和UTI为轻度且可治疗，严重感染罕见，因此强烈建议符合临床试验纳入标准的患者使用SGLT2抑制剂，其心血管和肾脏益处超过感染风险。对于所有SGLT2抑制剂使用者，预防策略、患者教育和仔细监测对于将感染风险降至最低至关重要。此外，我们探讨了弱势群体（如老年人、体弱和免疫功能低下患者）中SGLT2抑制剂尚未满足的需求，强调了基于真实世界数据的观察性研究的重要性。未来的研究应专注于识别高危人群，开发感染风险较低的SGLT2抑制剂，并制定有效的预防策略以降低与这些药物相关的生殖器和UTI风险。
