SGLT2 inhibitor therapy and lower incidence of iron deficiency anaemia in patients with type 2 diabetes: A retrospective cohort study from Germany

Aims Iron deficiency anaemia (IDA) is a common comorbidity in patients with type 2 diabetes mellitus (T2DM). Sodium–glucose cotransporter‐2 inhibitors (SGLT2i) have been shown to modulate erythropoiesis and iron metabolism, but their association remains unclear. This cohort study investigated whether SGLT2i use, compared to dipeptidyl peptidase‐4 inhibitors (DPP‐4i), is associated with a lower incidence of IDA in T2DM. Materials and methods We analysed data from the IQVIA™ Disease Analyzer, a German electronic medical records database (ICD‐10) from office‐based practices. Patients with T2DM (≥18 years) who initiated SGLT2i or DPP‐4i therapy alongside metformin between 2012 and 2022 were included. Those with prior anaemia diagnoses were excluded. Propensity score matching (1:1) was performed based on age, sex, baseline HbA1c, duration of metformin use, and anaemia‐related comorbidities. Kaplan–Meier analyses and Cox proportional hazards regression models were used to compare IDA incidence between cohorts over a 5‐year follow‐up. Results In total 28 441 propensity score matched patients per cohort were analysed. The cumulative 5‐year incidence of IDA was significantly lower in the SGLT2i (6.9%) versus DPP‐4i cohort (11.3%) ( p < 0.001). SGLT2i use was associated with a decreased risk of IDA (HR: 0.67; 95% CI: 0.58–0.78). Subgroup analyses confirmed this association in males and elder patients (>60 years), while the protective effect was limited to metformin use under 3 years. Conclusion SGLT2i therapy was associated with a lower incidence of IDA in T2DM patients compared to DPP‐4i therapy. These findings suggest a potential hematologic benefit of SGLT2 inhibitors, warranting further investigation in randomised controlled trials.