Diabetes Res Clin Pract. 2026 Oct 31:113639. doi: 10.1016/j.diabres.2026.113639. Online ahead of print.
ABSTRACT
Sodium glucose cotransporter 2 (SGLT2) inhibitors provide cardiovascular and renal benefits in type 2 diabetes mellitus, chronic kidney disease, and heart failure, but their use is associated with genitourinary (GU) infections and medication-safety concerns during antimicrobial treatment. This narrative review integrate evidence regarding SGLT2 inhibitor-associated GU infections, antimicrobial-antidiabetic drug interactions, pharmacovigilance, clinical management, and antimicrobial stewardship. Evidence from randomized controlled trials, meta-analysis, observational studies, pharmacokinetic studies and pharmacovigilance databases were used to synthesise on infection risk, drug interactions, management and safety issues in vulnerable populations. To identify relevant evidence narrative review was completed with evidence found in Pubmed, Google scholar, Clinical trial gov between 2020 and 2026. A purposive selection of literature was conducted to identify studies relevant to the article with a methodological strength, and not a systematic search was used.SGLT2 inhibitors demonstrate a more consistent association with genital mycotic infections than urinary tract infections (UTIs). Most GU infections are mild to moderate and can be treated with standard antimicrobial or antifungal therapy without routine discontinuation of SGLT2 inhibitors. SGLT2 inhibitors have low potential for drug-drug interactions, however, exposure to other agents can altered by strong enzyme inducers like rifampin, and this effect varies by SGLT2 inhibitor. Pharmacovigilance complements trial evidence by identifying safety signals, although disproportionality signals require clinical validation. Antimicrobial stewardship also enables treatment, avoidance of unnecessary prophylaxis, evaluation of risk factors, and assessment of concomitant medications and interactions.
PMID:42966404 | DOI:10.1016/j.diabres.2026.113639