Glucosuria as a Biomarker of Adherence to Sodium-Glucose Co-Transporter Protein Type 2 Inhibitors

Abstract

Purpose: Adherence to treatment with sodium-glucose co-transporter protein type 2 inhibitors (SGLT2i) is essential for the successful treatment of type 2 diabetes. As SGLT2i induce glucosuria, the main study objective was to assess the potential relationship between glucosuria level and adherence to SGLT2i. Patients and Methods: The study used electronic health records of patients aged ≥45 years old that had urinalysis data. Glucosuria was classified as absent/normal (0 mg/dL), intermediate (1–1000 mg/dL), and evident (>1000 mg/dL). Renal function, expressed by estimated glomerular filtration rate and stage of chronic kidney disease (CKD), was also assessed. Adherence to SGLT2i was measured with the proportion of days covered in 6 months. Results: Only 9.2% of samples showed evident glucosuria; of these, 87.5% belonged to patients treated with SGLT2i. Among these patients, glucosuria was mostly evident (78.9%). Absent glucosuria was more common in patients with CKD and in advanced KDIGO stages; therefore, in these patients glucosuria as adherence marker should be interpreted with caution.In patients treated with SGLT2i, absent glucosuria was detected in 4.5% of samples from patients with good adherence, 18.5% of samples from patients with intermediate adherence, and up to 38.5% of samples from patients with poor adherence (p <0.01). Absent glucosuria was also associated with higher blood uric acid level and lower hemoglobin and hematocrit. Absent glucosuria was more common in women and older patients. Conclusion: Absent glucosuria could be an easy biomarker of poor adherence in patients treated with SGLT2i in clinical practice.