Does Januvia Cause UTIs?
No, Januvia (sitagliptin) does not cause urinary tract infections. Unlike SGLT2 inhibitors which increase UTI risk through glucosuria, DPP-4 inhibitors like sitagliptin work through a completely different mechanism that does not involve urinary glucose excretion and therefore do not increase UTI risk 1.
Mechanism Explains the Safety Profile
Sitagliptin inhibits DPP-4 enzyme, which increases endogenous GLP-1 levels by preventing its degradation, thereby enhancing glucose-dependent insulin secretion without causing urinary glucose loss 1, 2.
No glucosuria occurs with sitagliptin, eliminating the primary mechanism by which some diabetes medications (specifically SGLT2 inhibitors) increase UTI risk 1.
Clinical Evidence on Safety
The 2025 American Diabetes Association guidelines list no UTI risk for DPP-4 inhibitors in their comprehensive safety profile, noting only pancreatitis (causality unestablished), arthralgia, and bullous pemphigoid as potential concerns 1.
Short-term adverse effects are limited to gastrointestinal symptoms (nausea, constipation, stomach discomfort, diarrhea) and upper respiratory infections, with no mention of genitourinary infections 2, 3, 4.
The drug has a weight-neutral effect, which contrasts with the weight loss seen with SGLT2 inhibitors that do carry UTI risk 1.
Critical Distinction from SGLT2 Inhibitors
SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin) DO cause UTIs through their mechanism of promoting urinary glucose excretion, with genitourinary tract infections listed as common adverse effects 1.
Higher doses of SGLT2 inhibitors increase UTI risk further, with dapagliflozin 10 mg showing significantly higher urinary frequency (
55% vs ~25%) and urgency (48% vs ~20%) compared to 5 mg doses 5.Guidelines specifically warn about UTI risk with SGLT2 inhibitors, recommending caution in patients with recurrent or severe UTIs and noting increased genital mycotic infections, especially in women 1.
Common Clinical Pitfall to Avoid
Do not confuse DPP-4 inhibitors with SGLT2 inhibitors when counseling patients about UTI risk. While both are newer diabetes medication classes, only SGLT2 inhibitors ("gliflozins") carry UTI risk due to their unique mechanism of causing glucosuria 1, 5.