Should we stop or continue SGLT-2 inhibitors following a UTI?

SGLT-2 inhibitors probably increase the risk of developing a urinary tract infection. Here researchers ask a great question: should we stop or continue SGLT-2 inhibitors after a patient develops a UTI.

This is a retrospective cohort study looking at patients with Type 2 Diabetes, and also taking an SGLT-2 inhibitor. Over 60,000 patients are included, and about 6% developed a UTI over 6.5 years.

Roughly 36% of the patients were women and the mean age was 63 years. Patients with a history of UTI were excluded. Patients who developed UTIs had more comorbid conditions including cancer, coronary artery disease, atrial fibrillation and stroke. But the mean hemoglobin A1c levels were very similar, 7.60% for those that did not develop a UTI, and 7.64% for those that did.

The bottom line: if someone developed a UTI and stopped taking the SGLT-2 inhibitor, they were more likely to have a major adverse cardiac event such as myocardial infarction or stroke, more likely to have significantly worsening kidney status, and more likely to die than if they continued taking the SGLT-2 inhibitor. Interestingly, stopping that medication was not associated with a decreased risk of developing a subsequent UTI.

This is a retrospective study, so interpreting the data has challenges. The patients who developed UTIs were less healthy than the patients who did not. But it certainly appears that we should continue SGLT-2 inhibitors even if someone develops a UTI.

In our CME, we also cover studies showing other benefits seen with SGLT2 inhibitors, such as lower rates of nephrolithiasis, development of gout, fewer gout flares, preservation of renal status, and lower all-cause mortality in those with Type 2 Diabetes. And of course, these medications are very beneficial in patients with heart failure regardless of their ejection fraction.

Reference: Wu et al. Urinary tract infection and continuation of sodium-glucose cotransporter-2 inhibitors in diabetic patients. Eur Heart Journ 2025 October 17; Online ahead of print