Introduction: The Clinical Paradox of SGLT2 Inhibition
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have redefined the therapeutic landscape for type 2 diabetes (T2D), providing significant cardiorenal protection and glycemic efficacy. However, their primary mechanism—the induction of therapeutic glycosuria—creates an environment in the urinary tract that may favor the growth of urogenital pathogens. Clinical experience has long noted a higher incidence of mycotic and bacterial infections in patients on SGLT2 inhibitors, which frequently leads to reduced compliance and treatment discontinuation. Interestingly, emerging clinical data suggests that the concomitant use of dipeptidyl-peptidase four (DPP-4) inhibitors might mitigate these adverse effects. A recent study by Calvigioni et al. (2026) provides a microbiological basis for this observation, exploring how these agents, alone and in combination, modulate the resident urinary microbiota.
