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. Plain Language Summary: Adherence to treatment is the degree to which a patient takes their medication as prescribed. As poor adherence is associated with reduced efficacy of treatment,early detection of low adherence is important, especially in chronic diseases such as diabetes. However, measuring adherence in clinical practice can be difficult. The objective of the study was to assess glucose (sugar) in urine as a marker of poor adherence in patients with diabetes treated with SGLT2i, a class of antidiabetic drugs characterized by increasing glucose in urine. Examples of SGLT2i are canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. Using electronic health records with urine analysis data, the researchers classified glucose in urine as absent (0 mg/dL), intermediate (1-1000 mg/dL), and evident (higher than 1000 mg/dL). Glucose was evident in 78.9% of urine samples, as expected because of the effect of SGLT2i of increasing glucose in urine. However, glucose was absent in a significant 9% of urine samples. Regarding the relationship between glucose in urine and adherence, glucose was absent in almost 40% of samples from patients with poor adherence. Furthermore, absent glucose in urine was more common in advanced stages of chronic kidney disease and therefore its value as an adherence marker should be interpreted with caution in these cases. Absent glucose in urine was also related to higher blood uric acid level and lower hemoglobin and hematocrit. The researchers concluded that glucose in urine could be an easy way to evaluate adherence in patients treated with SGLT2i in clinical practice. Keywords: diabetes mellitus, type 2 diabetes, glucosuria, adherence, sodium-glucose co-transporter protein type 2 inhibitors
Escribano-Serrano et al. (Sun,) studied this question.