Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as empagliflozin (podcast) (Jardiance) and dapagliflozin (Farxiga), are commonly used to manage type 2 diabetes. These medications can also provide important cardiovascular and kidney benefits. However, increased glucose in the urine can contribute to genital mycotic infections, making it important to monitor patients for genitourinary adverse effects. It’s critical to review the medication list for SGLT2 inhibitors when a patient encounters recurrent infections.
A Case of Recurrent Genitourinary Infections
A 68-year-old female with type 2 diabetes, hypertension, and chronic kidney disease is taking metformin and lisinopril. Her A1c is 8.1%, and her primary care provider adds empagliflozin 10 mg daily to improve glycemic control and provide kidney protection.
Over the next 12 months, the patient experiences three genitourinary infections. She develops two episodes of vaginal itching and irritation diagnosed as vulvovaginal candidiasis and one episode of dysuria and urinary frequency diagnosed as a urinary tract infection (UTI). Each episode is treated, but the patient is frustrated by the recurring symptoms. The patient is very frustrated with these infections.
What Should We Recommend?
SGLT2 inhibitors are associated with an increased risk of genital fungal infections (excellent board exam nugget). The evidence for contributing to bacterial UTIs isn’t quite as strong but should still be considered as a possibility. The patient is obviously frustrated with the recent infections and it is reasonable to conclude that empagliflozin may be contribuiting. I’d look at the past history of infections, and if this is a new problem, I’d be looking to potentially transition this patient off the SGLT2 inhibitor. A GLP-1 agonist would seem like a reasonable alternative to the SGLT2 if something more is needed.
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