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LETTER TO THE EDITOR
Year : 2023  |  Volume : 55  |  Issue : 5  |  Page : 338-339
 

Baseline predictors of genital mycotic infections following sodium-glucose cotransporter-2 inhibitors initiation in men with type 2 diabetes


1 Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
2 Department of Medicine, B.P. Poddar Hospital and Medical Research Ltd, Kolkata, West Bengal, India
3 Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India

Date of Submission19-May-2023
Date of Decision05-Aug-2023
Date of Acceptance29-Aug-2023
Date of Web Publication02-Nov-2023

Correspondence Address:
Satinath Mukhopadhyay
Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata - 700 020, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijp.ijp_307_23

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How to cite this article:
Banerjee M, Mukherjee A, Hazra A, Mukhopadhyay S. Baseline predictors of genital mycotic infections following sodium-glucose cotransporter-2 inhibitors initiation in men with type 2 diabetes. Indian J Pharmacol 2023;55:338-9

How to cite this URL:
Banerjee M, Mukherjee A, Hazra A, Mukhopadhyay S. Baseline predictors of genital mycotic infections following sodium-glucose cotransporter-2 inhibitors initiation in men with type 2 diabetes. Indian J Pharmacol [serial online] 2023 [cited 2023 Nov 28];55:338-9. Available from: https://www.ijp-online.com/text.asp?2023/55/5/338/389233




Dear Editor,

Individuals with type 2 diabetes mellitus (T2DM) have a 3–5-fold increased risk of developing genital mycotic infections (GMI) following treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i), usually attributed to the glucosuric effect of the drugs.[1] GMI negatively impacts sexual activity and quality of life, sometimes leading to polypharmacy and treatment discontinuations. It has previously been found that men have a higher risk of GMI within 30 days of SGLT2i use than women.[2] This risk of GMI may deprive men of the cardio-renal-metabolic benefits of this group of drugs.[3],[4] The notion that circumcision status may influence the risk of developing SGLT2i-associated GMI has not been prospectively evaluated to date. This study aimed to prospectively explore the impact of different baseline patient characteristics, i.e. duration of diabetes, glycemic status, and circumcision, on the risk of SGLT2i-associated GMI in T2DM.

After a formal ethical clearance from the Institutional Ethics Committee, a total of 306 men with T2DM, initiated on SGLT2i at our diabetes clinic, were prospectively followed up for 4 months. Inclusion criteria were men (≥30 years) with T2DM with glycated hemoglobin (HbA1c) 7%–10%, on stable doses of oral glucose-lowering medications, and those who gave informed consent to participate in the study. Patient demographic profile, circumcision status, diabetes duration, and HbA1c, measured with high-performance liquid chromatography method by Bio-Rad D-10 Analyzer, were recorded.

A total of 26 incidents of GMIs (balanoposthitis, n = 16; balanitis, n = 10) were reported during the study period. Compared to individuals not developing GMI (n = 280), individuals developing GMI (n = 26) had longer disease duration but similar age, body mass index, HbA1c, and effective glomerular filtration rate at baseline [Table 1]. None of the circumcised men (n = 55) developed GMI. There were no differences in HbA1c or diabetes duration between circumcised versus uncircumcised men (P > 0.05).
Table 1: Baseline characteristics of type 2 diabetes mellitus individuals developing genital mycotic infections and no genital mycotic infections

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Although the risk of urinary tract infection has not been found to be significantly elevated, SGLT2i initiation has consistently shown a higher risk of GMI in people with diabetes in available meta-analyses.[5] Duration of diabetes, but not baseline HbA1c, emerged as a predictor of the development of GMI in this study. This can be attributed to an impaired immune response, a high risk of mucosal damage, and endothelial dysfunction with impaired tissue vascularization in individuals with long-standing diabetes. Despite the presence of similar diabetes duration or baseline HbA1c compared to uncircumcised males, circumcised males showed a reduced risk of developing GMI on follow-up. These findings support the premise that the preputial skin in uncircumcised men may indeed facilitate the adherence and multiplication of the fungi, thereby contributing to a higher risk of GMI.

In conclusion, the present findings suggest a protective effect of circumcision on the risk of SGLT2i-associated GMI and underscore the importance of patient counseling and greater vigilance before initiating SGLT2i in uncircumcised males with long-standing T2DM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital infections with sodium glucose cotransporter-2 inhibitors: Occurrence and management in patients with type 2 diabetes mellitus. Indian J Endocrinol Metab 2018;22:837-42.  Back to cited text no. 1
    
2.
Lega IC, Bronskill SE, Campitelli MA, Guan J, Stall NM, Lam K, et al. Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: A population-based study of older women and men with diabetes. Diabetes Obes Metab 2019;21:2394-404.  Back to cited text no. 2
    
3.
Banerjee M, Pal R, Nair K, Mukhopadhyay S. SGLT2 inhibitors and cardiovascular outcomes in heart failure with mildly reduced and preserved ejection fraction: A systematic review and meta-analysis. Indian Heart J 2023;75:122-7.  Back to cited text no. 3
    
4.
Banerjee M, Pal R, Maisnam I, Chowdhury S, Mukhopadhyay S. Serum uric acid lowering and effects of sodium-glucose cotransporter-2 inhibitors on gout: A meta-analysis and meta-regression of randomized controlled trials. Diabetes Obes Metab 2023;25:2697-703.  Back to cited text no. 4
    
5.
Qiu M, Ding LL, Zhang M, Zhou HR. Safety of four SGLT2 inhibitors in three chronic diseases: A meta-analysis of large randomized trials of SGLT2 inhibitors. Diab Vasc Dis Res 2021;18:14791641211011016.  Back to cited text no. 5
    



 
 
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