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This study investigates the impact of SGLT2 inhibitor therapy on post-pneumonia outcomes in adults with type 2 diabetes mellitus.

May 27, 2026Open Access

Sodium–glucose cotransporter-2 inhibitor therapy and risk of mortality and morbidity following hospitalization for pneumonia in type 2 diabetes mellitus: An international propensity score-matched cohort study

Key Points

This study investigates the impact of SGLT2 inhibitor therapy on post-pneumonia outcomes in adults with type 2 diabetes mellitus.
Utilized TriNetX database for a cohort study of hospitalized adults with type 2 diabetes for pneumonia from Jan 2013 to Mar 2025.
Patients were categorized based on SGLT2 inhibitor prescription within 90 days before hospitalization.
Primary outcome included all-cause mortality within 30 days; secondary outcomes were major adverse respiratory events, acute kidney injury, and diabetic ketoacidosis.
SGLT2 inhibitor users had a 30-day mortality rate of 8.72% compared to 12.27% in non-users (RR: 0.71, 95% CI: 0.64–0.79, p < 0.0001).
Significantly lower rates of major adverse respiratory events (RR: 0.87, 95% CI: 0.84–0.91, p < 0.0001) and acute kidney injury (RR: 0.89, 95% CI: 0.84–0.94, p < 0.0001) were also observed.
Diabetic ketoacidosis occurred less often in SGLT2 inhibitor users (RR: 0.53, 95% CI: 0.29–0.98, p = 0.0387).

Abstract

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular and renal benefits in type 2 diabetes mellitus (T2DM). Objectives: This study investigated the association between SGLT2 inhibitor therapy and mortality and morbidity after hospitalization for pneumonia among adults with T2DM. Design: International retrospective propensity score-matched cohort study. Methods: We conducted a cohort study using the TriNetX database, including adults with T2DM who were hospitalized for pneumonia between January 1, 2013, and March 31, 2025. Patients were categorized based on whether they had received a prescription for SGLT2 inhibitors within 90 days before the index admission. The primary outcome was all-cause mortality within 30 days. Secondary outcomes included major adverse respiratory events (MAREs, comprising respiratory failure, acute respiratory distress syndrome, pleural effusion or empyema, sepsis, mechanical ventilation, and intensive care unit admission), acute kidney injury (AKI), and diabetic ketoacidosis (DKA). Results: Among the 6505 matched patients, SGLT2 inhibitor users had significantly lower 30-day mortality (8.72% vs 12.27%; relative risk (RR): 0.71, 95% confidence interval (CI): 0.64–0.79, p < 0.0001), MAREs (RR: 0.87, 95% CI: 0.84–0.91, p < 0.0001), AKI (RR: 0.89, 95% CI: 0.84–0.94, p < 0.0001). Diabetic ketoacidosis (DKA) events were rare in both groups (0.25% vs 0.46%) but occurred less frequently among SGLT2 inhibitor users (RR: 0.53, 95% CI: 0.29–0.98, p = 0.0387). These findings were consistent across multiple follow-up periods and sensitivity analyses. Additionally, a dose–response relationship was observed between the duration of SGLT2 inhibitor use and reduced rates of all-cause mortality, MAREs, and AKI. Conclusion: Patients with T2DM who used SGLT2 inhibitors had significantly lower risks of mortality and morbidity following hospitalization for pneumonia, including a notable reduction in DKA, contrary to prior concerns. Randomized controlled trials are warranted to validate these findings.

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