Comparative risk of infection of medications used for type 2 diabetes.

Antonios Douros, Kristian B Filion, Estefania Zapata-Bravo, Oriana Hoi Yun Yu

Journal: Expert opinion on drug safety 2024;23(9):1079-1091

PMID: 39258857

Abstract

INTRODUCTION

Glucose-lowering drugs pose a potential infection risk among individuals with type 2 diabetes. The U.S. Food and Drug Administration has issued safety warnings regarding increased risks of urinary tract infections (UTIs) and genital infections with sodium-glucose cotransporter 2 (SGLT2) inhibitors. However, the infection risk associated with other glucose-lowering drugs remains unclear. We conducted a PubMed database search to review the infection risk of glucose-lowering drugs, focusing on meta-analysis of randomized controlled trials.

AREAS COVERED

We described the infection risks associated with SGLT2 inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucose-like peptide-1 receptor agonists, metformin, and thiazolidinediones, covering infections of the genitourinary, respiratory, and gastrointestinal systems, including skin and soft tissue infections (SSTIs).

EXPERT OPINION

SGLT2 inhibitors are associated with a higher genital infection risk, while their UTI risk remains inconclusive. DPP-4 inhibitors could be a treatment option for those intolerant to SGLT2 inhibitors, given their lower genital infection risk compared to placebo. Uncertainty persists regarding the risks of respiratory infections, gastroenteritis, and SSTIs with SGLT2 inhibitors. Limited evidence is available regarding the impact of DPP-4 inhibitors on respiratory infections. Additional research is needed to determine the comparative infection risk of other glucose-lowering drugs.

Address: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.; Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany.; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.; Division of Endocrinology and Metabolism, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.; Department of Medicine, McGill University, Montreal, QC, Canada.

DOI: 10.1080/14740338.2024.2401024