From the Research
Caution is advised when considering SGLT2 inhibitors for patients with interstitial cystitis (IC), as they may exacerbate bladder symptoms and are generally not recommended. The mechanism of action of SGLT2 inhibitors, which prevents glucose reabsorption in the kidneys, leading to increased urinary glucose excretion and increased urination frequency, may worsen symptoms of urinary urgency, frequency, and bladder pain in IC patients 1. Additionally, SGLT2 inhibitors slightly increase the risk of urinary tract infections, which could be particularly problematic for IC patients who may have compromised bladder protective barriers.
Key Considerations
- IC patients already experience urinary urgency, frequency, and bladder pain, which could be worsened by SGLT2 inhibitors
- Alternative diabetes medications such as metformin, DPP-4 inhibitors, GLP-1 receptor agonists, or insulin might be more appropriate options for patients with both diabetes and IC
- Any decision to use SGLT2 inhibitors in an IC patient should involve careful consideration of the potential risks versus benefits and close monitoring for worsening bladder symptoms
Clinical Guidelines
The clinical guidelines for interstitial cystitis/bladder pain syndrome, as outlined in the International Journal of Urology, define IC as a condition with chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by other urinary symptoms, such as persistent urge to void or urinary frequency in the absence of confusable diseases 1. These guidelines emphasize the importance of a multidisciplinary approach for optimum outcome and highlight the need for careful consideration of treatment options, including the potential risks and benefits of SGLT2 inhibitors.
Treatment Options
If a patient with both diabetes and IC requires treatment, alternative diabetes medications such as metformin, DPP-4 inhibitors, GLP-1 receptor agonists, or insulin might be more appropriate options that won't exacerbate bladder symptoms 1. The choice of treatment should be based on a careful evaluation of the patient's individual needs and medical history, and should involve close monitoring for worsening bladder symptoms.