Cardiovascular Outcomes of Patients With Type 2 Diabetes With Urinary Tract Infection Post Sodium-Glucose Cotransporter 2 Inhibitors Treatment: A Multicenter Observational Study

OBJECTIVE: Urinary tract infection (UTI) is an adverse effect of sodium-glucose cotransporter 2 inhibitors (SGLT2is). However, its effect on cardiovascular outcomes in type 2 diabetes mellitus (T2DM) patients remains unclear.

METHODS: This multicenter retrospective observational study included diabetes patients who received SGLT2is between January 2016 and January 2019. Major adverse cardiovascular events (MACEs) were defined as a composite of nonfatal myocardial infarction, nonfatal stroke, cardiac death, all-cause death, or hospitalization due to heart failure. Outcomes were compared between patients with and without UTI. Multivariate analyses were conducted to adjust for baseline characteristics that might influence the outcomes.

RESULTS: We retrospectively reviewed 8862 T2DM patients who had been treated with SGLT2i. In total, 550 patients were identified as having UTIs and requiring antibiotics after SGLT2i treatment. We followed up on the cardiovascular outcomes for 30 months after SGLT2i treatment. After adjusting significant baseline characters, the UTI group exhibited increased risk of MACE (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] = 1.60-2.57, P < .0001), heart failure hospitalization (aHR = 1.66, 95% CI = 1.32-2.09, P < .0001), and all-cause mortality (aHR = 2.67, 95% CI = 2.10-3.40), P < .0001).

CONCLUSION: UTI in patients with T2DM post-SLGT2i therapy is associated with an increased risk of MACE for up to 30 months.