Endocrine Abstracts

Objective: The study aims to investigate the association between asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitors (SGLT2i) and urinary tract infection (UTI) risk in a cohort of women with type 2 diabetes mellitus (T2DM) (NCT05520684).

Methods: The female outpatients with T2DM under follow-up in the department of internal medicine and initiated SGLT2i (dapagliflozin/empagliflozin) were included between February and September 2022. Exclusion criteria were; being symptomatic for UTI or genital infection at the initiation, being treated for UTI or genital infection in the past 3 months or having a high risk for UTI (any urological disease/catheter use, cancer, immunodeficiency, bedridden). Hospitalization and antibiotic use for indications other than UTI were exclusion criteria during follow-up. Automated urinalysis and urine culture were obtained on the SGLT2i initiation day. Pyuria was defined as ≥3 white cells per high-power field. Any bacterial growth in the culture reported by the microbiology laboratory was defined as bacteriuria. All patients were followed up for 3 months after SGLT2i initiation. UTI diagnosed or treated by any physician was recorded as the outcome. Cumulative incidence and relative risk of UTI were analyzed for pyuria and bacteriuria.

Results: 143 female patients were included. 13 patients were excluded during follow-up (antibiotic use n=7, hospitalization for CABG n=1, DHF n=1, NSTEMI n=1, CVA n=1, acute pancreatitis n=1, PTE n=1). The median age was 62 (range 34-87). 20.8% of the patients (n=27) had cardiovascular disease. Median HbA1c was 9.1%(range 5.9-13.9). Median creatinine and eGFR were 0.79 mg/dl (range 0.4-1.77) and 80 ml/min (range 32-120), respectively. 41.5% of the patients (n=54) had pyuria and 28.5% (n=37) had bacterial growth in urine culture. The most common microorganisms were E. coli (n=13, 35%) and S. agalactiae (n=7, 19%). Dapagliflozin was initiated in 70% of patients (n=91). The cumulative incidence of the UTI was 20%(n=26/130) in the whole cohort, 25,9% (n=14/54) in the pyuria group and 18.9% (n=7/37) in the bacteriuria group. The relative risk of UTI was 1.64 (95% CI: 0.82-3.26) for pyuria, 0.92 (95% CI: 0.42-2.01) for bacteriuria and 1.2 (95% CI: 0.47-3.08) for pyuria plus bacteriuria. Multiple logistic regression analysis including the variables of age, HbA1c, CVD as comorbidity, eGFR, pyuria, bacteriuria and SGLT2i type did not reveal any statistical significance.

Conclusions: In this pragmatic practical cohort study, pyuria or bacteriuria at the initiation of SGLT2 inhibitor are not risk factors for UTI for female patients with type 2 DM in a 3-month-follow-up.