Lee Alexandra K, Lipska Kasia J, Callahan Kathryn E, Raphael Eva, Lee Sei J
Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA.
BMJ Open Diabetes Res Care. 2025 Jul 31;13(4):e004929. doi: 10.1136/bmjdrc-2025-004929.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended as first-line cardiorenal protective therapy in type 2 diabetes. Because SGLT2is cause glycosuria and increase urine volume, they may exacerbate incontinence symptoms among patients with pre-existing urinary incontinence. Our objective was to determine how many adults meeting guideline indications for SGLT2i have frequent urinary incontinence.
We conducted a cross-sectional analysis of National Health And Nutrition Examination Survey (NHANES) participants aged ≥55 with type 2 diabetes in 2013-2020. We determined whether participants met American Diabetes Association guideline indications for an SGLT2i due to heart failure or chronic kidney disease, or due to atherosclerotic cardiovascular disease or high cardiovascular risk (for the latter two cardiovascular indications, GLP-1RAs are guideline-recommended alternative medications). Frequent urinary incontinence was defined by self-report of leaking urine daily/nightly or a few times per week.
There were 1726 NHANES participants aged ≥55 with type 2 diabetes, representing 16.0 million US adults; 19.6% (95% CI 17.3% to 22.2%) (3.1 million) met indications for an SGLT2i specifically and 50.9% (95% CI 47.2% to 54.7%) (8.2 million) met indications for either an SGLT2i or a GLP-1RA. Among those with indications for an SGLT2i specifically, 32.4% (95% CI 25.9% to 39.8%) had frequent urinary incontinence, representing 333 000 men and 685 000 women. Among those with indications for either an SGLT2i or GLP-1RA, 25.5% (95% CI 20.8% to 30.8%) had frequent urinary incontinence, representing 630 000 men and 1413 000 women.
Frequent urinary incontinence affects >15% of men and >40% of women aged ≥55 years with guideline indications for SGLT2i. Studies are needed to determine if incontinence increases risk of genital infections when initiating SGLT2is.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）被推荐作为2型糖尿病的一线心脏肾脏保护治疗药物。由于SGLT2i会导致糖尿并增加尿量，它们可能会使已有尿失禁症状的患者的失禁症状加重。我们的目的是确定符合SGLT2i指南适应证的成年患者中，有多少人存在频繁尿失禁的情况。
我们对2013年至2020年年龄≥55岁的2型糖尿病国家健康与营养检查调查（NHANES）参与者进行了横断面分析。我们确定参与者是否因心力衰竭或慢性肾脏病，或因动脉粥样硬化性心血管疾病或高心血管风险而符合美国糖尿病协会SGLT2i的指南适应证（对于后两种心血管适应证，胰高血糖素样肽-1受体激动剂[GLP-1RAs]是指南推荐的替代药物）。频繁尿失禁的定义为自我报告每天/每晚或每周几次漏尿。
共有1726名年龄≥55岁的NHANES 2型糖尿病参与者，代表1600万美国成年人；19.6%（95%CI 17.3%至22.2%）（310万）专门符合SGLT2i的适应证，50.9%（95%CI 47.2%至54.7%）（820万）符合SGLT2i或GLP-1RA的适应证。在专门符合SGLT2i适应证的人群中，32.4%（95%CI 25.9%至39.8%）存在频繁尿失禁，其中男性33.3万，女性68.5万。在符合SGLT2i或GLP-1RA适应证的人群中，25.5%（95%CI 20.8%至30.8%）存在频繁尿失禁，其中男性63万，女性141.3万。
频繁尿失禁影响了年龄≥55岁且符合SGLT2i指南适应证的男性中的>15%和女性中的>40%。需要开展研究以确定开始使用SGLT2i时失禁是否会增加生殖器感染风险。
