Predictors and Outcomes of Erythrocytosis After Sodium-Glucose Cotransporter-2 Inhibitors in Type 2 Diabetes Mellitus
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Abstract
Background: Current evidence suggests that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i) may increase hemoglobin levels. An increase in hemoglobin may be beneficial in improving cardiovascular and renal outcomes. This study examined changes in hemoglobin, the prevalence, and predictors of erythrocytosis in patients with type 2 diabetes mellitus (T2DM) who received SGLT2i. The associations between erythrocytosis with cardiovascular events and renal outcomes were also investigated.
Methods: This retrospective study was conducted in patients with T2DM who received SGLT2i for at least 3 consecutive months between January 2020 and December 2022. Hemoglobin and hematocrit were collected at baseline and after 3-12 months of SGLT2i treatment until the end of the study. Erythrocytosis was defined as an increase in hemoglobin level ≥2 gm/dL from baseline during the study period.
Results: Three hundred thirty-six patients were included in the study. The prevalence of erythrocytosis was 125 patients (37.2 %). The hemoglobin levels increased over time with median differences from baseline of 0.7, 1, 1.3, and 1.5 gm/dL at 3, 6, 12, and >24 months, respectively. The predictors of erythrocytosis were age >60 years, chronic kidney disease, using thiazide and beta-blockers, lower hemoglobin, and estimated glomerular filtration rate at baseline. Cardiovascular and renal outcomes were not different between the erythrocytosis and non-erythrocytosis groups.
Conclusion: A gradual increase in hemoglobin levels was observed in patients with T2DM after SGLT2i treatment. Erythrocytosis was common but was not associated with adverse cardiovascular events or renal outcomes.
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