Sodium glucose cotransporter 2 inhibitors and males lower urinary tract symptoms, an aspect to consider

Dear Editor:

Lower urinary tract symptoms (LUTS) are common in adults with diabetes mellitus, particularly in males, and they represent a considerable burden for the health of these patients. Thus, the mean prevalence of LUTS in men with type 2 diabetes mellitus (DM2) may range from 30% to 52%. Predisposing factors include the presence of benign prostatic hyperplasia and autonomic neuropathy.¹

The latest recommendations for patients with DM2 include a new therapeutic family of oral antidiabetic drugs: Sodium-glucose co-transporter 2 inhibitors (SGLT2i), which may be added to metformin or sulfonylureas plus metformin when glycemic targets have not been reached. This cotransporter is responsible for most of the reabsorption of glucose from the renal tubule lumen, so its inhibition increases the urinary excretion of glucose and therefore decreases the plasma concentrations. Canagliflozin, dapagliflozin and empagliflozin belong to this group.² Treatment with SGLT2i is usually associated to genital and urinary tract infections but LUTS have rarely been investigated in patients treated with SGLT2i recently.

A recent retrospective case series study has shown a very high prevalence of new-onset urinary frequence and nocturia in a cohort of diabetic male patients recently treated with SGLT2i, while other reported LUTS had been developed prior to initiation of SGLT2i treatment. These data suggest that LUTS may be a significant problem for diabetic patients treated with SGLT2i in clinical practice. In particular, nocturia can have a severe impact on quality of life. In addition, it was observed that patients without autonomic neuropathy reported more severe symptoms than patients with neuropathy. This finding emphasizes that the high prevalence of LUTS in this population has not been affected by the presence of bladder dysfunction, which in turn could be related to autonomic neuropathy.³

In conclusion, new-onset urinary frequence and nocturia may be frequently reported by male patients initiating SGLT2i treatment, regardless of their predisposing comorbidities. This aspect should be considered when choosing this treatment, although these preliminary results should be validated by observational studies.