Association of SGLT2 Inhibitor Use with Glycosuria, Pyuria, Urinary Symptoms, and Significant Urine Culture Positivity in Adults with Type 2 Diabetes: A Prospective Cross-Sectional Study

Background and Objectives: Sodium–glucose cotransporter 2 (SGLT2) inhibitors increase urinary glucose excretion, but the relationship between glycosuria and findings supporting urinary tract infection (UTI) remains unclear. We evaluated associations of SGLT2 inhibitor use with glycosuria, pyuria, UTI-compatible symptoms, and significant urine culture positivity in adults with type 2 diabetes. Materials and Methods: This prospective cross-sectional study included 251 adults who reported using every agent in their current oral antidiabetic regimen for at least three months. Blood tests, urinalysis, and midstream urine culture were obtained at a single study visit. SGLT2 inhibitor users and nonusers were compared; contaminated cultures were excluded from culture-based analyses. Multivariable logistic regression examined factors associated with glycosuria and pyuria. Results: Overall, 108 participants (43.0%) used an SGLT2 inhibitor (dapagliflozin, n = 51; empagliflozin, n = 57). Glycosuria was more frequent among users than nonusers (69.4% vs. 39.9%; OR = 3.43; 95% CI, 2.02–5.82; p < 0.001). In multivariable analysis, SGLT2 inhibitor use (adjusted OR = 3.14; 95% CI, 1.75–5.63) and each 1% increase in HbA1c (adjusted OR = 1.56; 95% CI, 1.27–1.92) were independently associated with glycosuria. Pyuria and UTI-compatible symptoms did not differ between groups. Among 217 evaluable cultures, significant culture positivity was numerically higher among users, but the estimate was imprecise (9.5% vs. 4.1%; OR = 2.45; 95% CI, 0.79–7.57; p = 0.110). Symptomatic culture positivity was similar (4.2% vs. 4.1%; p = 1.000). Conclusions: SGLT2 inhibitor use and higher HbA1c levels were independently associated with glycosuria. The small number of culture-positive events precludes firm conclusions about culture-based outcomes; these analyses are exploratory and do not demonstrate the presence or absence of an association. Glycosuria alone should not be interpreted as an indicator of UTI.