SGLT2 Inhibitors and the Associated Risk of Genito Mycotic Infections – A Narrative Review

Abstract

The increased prevalence of Diabetes mellitus, the comorbid associations and complications among the global population has led to a dependency for treatment options with multiple modalities. One such option is the SGLT2 inhibitor (SGLT2i) class of drugs. SGLT2i have been demonstrated to improve glycemic control while providing cardiovascular (CV) and renal benefits in patients with T2DM. SGLT2 inhibitors comprising of canagliflozin, dapagliflozin, empagliflozin, ertugliflozin and remogliflozin are indicated in T2DM individuals with CV complications or chronic kidney disease (CKD). Although generally well tolerated, they pose some important safety concerns. The most common side effect of SGLT2i administration being Genital Mycotic Infections (GMI) and Symptomatic Volume Depletion. Meta-analysis and large clinical trials have reported an incidence of 2.5% to 6.5% of GMI, and a 4-6-fold increased risk of GMI among patients on SGLT2i. This narrative review evaluates the recent literature on SGLT2i and the incidence and severity of GMI. The review aims to help guide health care professionals involved in clinical care for patients on SGLT2 inhibitors. The existing literature evidence suggests that the GMI associated with SGLT2i therapy are generally mild and respond well to the conventional treatment. Major risk factors of infection are female, poor hygiene, prior infection, and uncircumscribed men. Perineal hygiene and treatment with standard antifungal agents could effectively decrease the incidence of such infections and may not warrant strict discontinuation of SGLT2i therapy. Active patient participation and awareness during treatment initiation is helpful in early recognition of symptoms and timely interventions.