Genital infections with sodium glucose cotransporter-2 inhibitors: Occurrence and management in patients with type 2 diabetes mellitus

• Published in: Indian journal of endocrinology and metabolism 2018-11, Vol.22 (6), p.837-842
• Main Authors: Unnikrishnan, A, Kalra, Sanjay, Purandare, Vedavati, Vasnawala, Hardik
• Format: Article
• Language: English
• Subjects: Analysis; Antidiabetics; Balanitis; balanoposthitis; Blood glucose; Care and treatment; Comorbidity; Complications and side effects; Diabetes; Diabetes mellitus; Diabetes therapy; Dosage and administration; Drug therapy; Fungi; genital infection; Glucose; glucosuria; Hygiene; Hyperglycemia; Hypoglycemic agents; Immune system; Infection; Infections; Metabolism; Prevalence studies (Epidemiology); Proteins; Review; Risk factors; SGLT2i; Sodium; Type 2 diabetes; Urogenital diseases; vulvovaginal candidiasis; Womens health
• ISSN: 2230-8210; 2230-9500
• DOI: 10.4103/ijem.IJEM_159_17

Diabetes is a metabolic disorder characterized by hyperglycemia and is associated with several comorbidities and complications. Genital infection is one such complication that is often associated with diabetes mellitus (DM). Even though abnormalities in immune system, high urine glucose, and bladder dysfunction are important contributors for the increased risk of genitourinary symptoms, yet the possible role of pharmacologically induced glucosuria cannot be completely overlooked in such patients. There are various classes of medications to control blood glucose levels. A new therapeutic option to manage hyperglycemia is to increase renal glucose excretion by inhibiting sodium-glucose cotransporter-2 (SGLT2) glucose transport proteins. SGLT2 inhibitors (SGLT2i) represent a novel class of oral antidiabetic drugs which are associated with drug-induced glucosuria. Currently, canagliflozin, dapagliflozin, and empagliflozin are the three SGLT2i approved for therapy in Type 2 DM (T2DM). Safety studies with these three SGLT2i have reported events of mild-moderate genital infections in patients on SGLT2i therapy. However, most of the reported infections responded to standard treatment. Apart from SGLT2i, factors including personal hygiene, menopause, and circumcision might have a possible role in reported events of genital infections among T2DM patients on SGLT2i therapy. The present review identifies the occurrence of genital infections in diabetic patients on SGLT2i therapy, factors affecting the incidence of genital infections, and management strategies in patients with T2DM on SGLT2i therapy.