SGLT2 inhibitors raise genital but not urinary infection risk

In a nationwide cohort of 41,801 South Korean adults with type 2 diabetes and chronic kidney disease, researchers emulated a target trial comparing 6,385 initiators of SGLT2 inhibitors with 35,416 initiators of DPP-4 inhibitors between 2016 and 2023. After inverse probability of treatment weighting, SGLT2 inhibitor initiation showed no association with increased urinary tract infection risk (HR, 0.99; 95% CI, 0.83-1.17). However, SGLT2 inhibitors were associated with a modestly higher risk of genital tract infections (HR, 1.31; 95% CI, 1.09-1.58). Severe infections requiring emergency visits or hospitalization did not differ between the two drug classes. Subgroup analyses revealed that the excess genital tract infection risk clustered early after treatment initiation and was most pronounced among women aged 65 to 79 years.