Sodium/Glucose Cotransporter Inhibitors, Refractory Hypomagnesemia, and Recurrent Genital Mycotic Infections

We previously reported that sodium-glucose cotransporter 2 (SGLT2) inhibitors can be a treatment option for refractory hypomagnesemia when all other conventional therapeutic options have failed, demonstrating clinically meaningful and sustained improvements in serum magnesium levels in patients with or without type 2 diabetes mellitus (T2DM) (1, 2). However, SGLT2 inhibitors are also associated with a significantly increased risk of genital mycotic infections, estimated at 4–6-fold higher than with placebo (3), and with a correspondingly higher likelihood of treatment discontinuation (hazard ratio 1.48) (4). This creates a clinical dilemma for patients who derive substantial benefits from these agents yet experience recurrent infections. Here, we describe our real-world experience using long-term suppressive antifungal therapy to enable continuation of SGLT inhibitor therapy in such individuals.