title: Genitourinary infections in diabetic patients in the new era of diabetes therapy with sodium-glucose cotransporter-2 inhibitors.
abstract: To review prevalence and significance of urinary tract (UTI) and genital infections (GI) in diabetes and the effects of sodium glucose cotransporter 2 (SGLT-2) inhibitors on these complications.
  
  
  
  The prevalence of asymptomatic bacteriuria (ASB) is 2-3 times higher in diabetic than in non-diabetic women. The treatment of ASB has no impact on the development of UTIs and/or a decline in renal function. Therefore, there is no indication for screening for and/or treatment of ASB. The incidence of UTI is higher and frequently complicated in diabetic patients, particularly in those with longer duration of disease and of older age. There is no consistent evidence of an association between A1c levels, glycosuria and the risk of ASB and/or UTIs. Diabetes is a known risk factor for Candida colonization and GI, and a poor glycemic control is associated with a higher risk. While patients treated with SGLT-2 inhibitors may have a non-significant increased risk of UTI, they have a clearly increased risk of GI; most of these infections are mild, easy to treat, and the rate of recurrence is low.
  
  
  
  Diabetic patients are at high risk of UTIs and of GI. Only GI are associated with poor glycemic control. Although patients treated with SGLT-2 inhibitors have an increased 3-5 fold risk of GI, proper medical education can reduce this risk.
authors: Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
authors: M
authors: M
authors: Rizzi
authors: Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy. Electronic address: rtrevisan@asst-pg23.it.
authors: R
authors: R
authors: Trevisan
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005831:Genital Diseases, Female / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005832:Genital Diseases, Male / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D051297:Sodium-Glucose Transporter 2 / Q000378:metabolism; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D014552:Urinary Tract Infections / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D051297:Sodium-Glucose Transporter 2; D000077203:Sodium-Glucose Transporter 2 Inhibitors; C089180:SLC5A2 protein, human; C517652:hemoglobin A1c protein, human
keywords: Asymptomatic bacteriuria; Diabetes; Genital infection; Glycosuria; Sodium glucose cotransporter 2 inhibitors; Urinary tract infection