Insights into the Complications of SGLT-2 Inhibitors in Patients with Type 2 Diabetes: Real-World Outcomes

Introduction: Diabetes mellitus (DM) has become a global health crisis, and according to the International Diabetes Federation (IDF), over 700 million adults are projected to have diabetes by 2045. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have emerged as a promising treatment; however, concerns have arisen regarding their safety and potential complications. This study aims to investigate the incidence of complications in patients with diabetes who are using SGLT-2 inhibitors. Methodology: A retrospective study was conducted at a university hospital, analyzing patients with diabetes who were on Empagliflozin and Dapagliflozin. The variables analyzed were divided into four sections. Results: In total, 167 patients with type 2 DM were included, all of whom were on SGLT-2 inhibitors for more than three months. The mean age of participants was 59 ± 10 years, and 29% were smokers of 32.0 ± 21.2 pack-years. The most common comorbidity was hypertension (54.3%). Approximately 27% of the patients developed urinary tract infections (UTIs), with female (64.9%) predominance compared to males (35.1%) (p = 0.004). Patients with UTIs were younger (mean age 54 ± 11.8 years) and had a shorter diabetes duration (12 ± 10 years) than those without UTIs (p ≤ 0.008). Only 5.8% of patients had foot infections, and 2.2% had foot ulcers. Laboratory results showed stable BUN, creatinine, and electrolyte levels, with significant improvements in lipid profiles at 6 and 12 months. HbA1c levels decreased from a baseline of 8.31% ± 1.67 to 7.91% ± 1.40 at 3 months and 7.72% ± 1.40 at 6 months. A subgroup of 23 patients underwent physical examination, revealing that 13% had signs of lower limb ischemia, 52.2% to 60.9% had diminished vibration sensation, and over 60% had absent dorsalis pedis pulses. However, only 4.5% of this subgroup had foot infections. UTIs were reported in 27.3% of the subgroup. Among 27 patients who discontinued SGLT-2 inhibitors within six months, UTIs were the most common cause (29.6%).