Acta Diabetologica

, Volume 55, Issue 5, pp 503–514 | Cite as

SGLT-2 inhibitors and the risk of infections: a systematic review and meta-analysis of randomized controlled trials

  • Robert Puckrin
  • Marie-Philippe Saltiel
  • Pauline Reynier
  • Laurent Azoulay
  • Oriana H. Y. Yu
  • Kristian B. Filion
Original Article



There is concern about the infection-related safety profile of sodium–glucose co-transporter 2 (SGLT-2) inhibitors. We aimed to determine the effect of SGLT-2 inhibitors on genitourinary and other infections via systematic review and meta-analysis of randomized controlled trials (RCTs).


We conducted a systematic search of Medline, EMBASE, Cochrane Central Register of Controlled Trials, and to identify double-blinded RCTs enrolling ≥ 50 patients with type 2 diabetes which compared an SGLT-2 inhibitor to placebo or active comparator. Two independent reviewers extracted data and appraised study quality. Data were pooled using random-effects models.


Eighty-six RCTs enrolling 50,880 patients were included. SGLT-2 inhibitors increased the risk of genital infections compared to placebo (relative risk [RR] 3.37, 95% CI 2.89–3.93, I2 0%) and active comparator (RR 3.89, 95% CI 3.14–4.82, I2 0.3%). The risk of urinary tract infection (UTI) was not increased with SGLT-2 inhibitors compared to placebo (RR 1.03, 95% CI 0.96–1.11, I2 0%) or active comparator (RR 1.08, 95% CI 0.93–1.25, I2 22%). In drug-specific analyses, only dapagliflozin 10 mg daily was associated with a significantly increased risk of UTI compared to placebo (RR 1.33, 95% CI 1.10–1.61, I2 0%). SGLT-2 inhibitors were associated with a reduced risk of gastroenteritis (RR 0.38, 95% CI 0.20–0.72, I2 0%) but did not affect the risk of respiratory tract infections.


SGLT-2 inhibitors are associated with an increased risk of genital tract infections. Although there is no association overall between SGLT-2 inhibitors and UTI, higher doses of dapagliflozin are associated with an increased risk.


Sodium–glucose co-transporter 2 (SGLT-2) inhibitors Type 2 diabetes mellitus Infections Adverse events Systematic review and meta-analysis 



We wish to thank Mrs. Angella Lambrou, Liaison Librarian at the Life Sciences Library of McGill University, for her assistance in developing the database search strategies.

Authors contribution

RP and MS conducted the literature search, performed data extraction, and assessed study quality. PR conducted the statistical analyses. RP wrote the manuscript. All authors interpreted data and revised the manuscript for important intellectual content. RP and KBF designed the study. KBF conceived of the study idea, supervised the study, and is the guarantor.


Drs. Filion and Azoulay are supported by Fonds de Recherche du Québec—Santé (FRQS) Junior II awards.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical standard

This study used published, aggregate data and did not involve human participants or animals. Consequently, research ethics board review was not required.

Informed consent

Not applicable

Supplementary material

592_2018_1116_MOESM1_ESM.docx (8.2 mb)
Supplementary material 1 (DOCX 8421 kb)


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of MedicineUniversity of TorontoTorontoCanada
  2. 2.Deparment of MedicineMcGill UniversityMontrealCanada
  3. 3.Centre for Clinical EpidemiologyLady Davis InstituteMontrealCanada
  4. 4.Gerald Bronfman Department of OncologyMcGill UniversityMontrealCanada
  5. 5.Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
  6. 6.Division of EndocrinologyJewish General HospitalMontrealCanada

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