Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have now become established as important second line agents for the management of type 2 diabetes, and are known to have clinical glycaemic, renal and cardiovascular benefits. The development of genital mycotic infections is more common with SGLT2 inhibitors (overall incidence in clinical trials of 4% to 6%) compared to other oral hypoglycaemic agents, and can dissuade patients from persisting with treatment.

Aims: To determine whether the provision of hygiene advice is beneficial in the prevention of genital mycotic infections in patients commenced on SGLT2 inhibitors.

Methods: Patients in an outpatient setting were provided with hygiene advice to rinse the genital area with water after every void and before going to bed, when commencing an SGLT2 inhibitor including dapagliflozin, empagliflozin and canagliflozin. The incidence of genital mycotic infections in these patients was compared to patients who were not given hygiene advice whilst receiving an SGLT2 inhibitor during a three-year period (2015 to 2018) using a linear regression analysis considering the confounding factors of age, sex, glycaemic control (HbA1c) and previous genital mycotic infection.

Results: Of the 125 patients who received hygiene advice, 6 (4.8%) developed a genital mycotic infection, whereas 51 of the 125 patients (40.8%) who were not given hygiene advice developed a genital mycotic infection within the first 6 months. 15 of the 51 patients had mild infection and continued an SGLT2 inhibitor with antifungal treatment, and 36 stopped due to severe infection. There was a significant reduction in the risk of these infections (p = 0.015) in patients given hygiene advice, and compliance was significantly higher in this group (p = 0.012).

Conclusion: Personal hygiene advice should be provided for all patients commenced on SGLT2 inhibitor therapy to improve compliance with this clinically beneficial treatment.


S.M. Williams: None. S.H. Ahmed: None.

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