SGLT2 inhibitors linked to increased erythrocytosis but not higher thrombotic risk

While SGLT2 inhibitors (SGLT2i) increase erythrocytosis risk, this doesn’t appear to translate into elevated thrombotic risk.

Study details: This retrospective cohort study analyzed over 100,000 adults with T2DM initiating SGLT2 inhibitors, comparing them with matched cohorts on DPP-4 inhibitors or GLP-1 RAs. Primary outcomes were incidence of erythrocytosis and thrombotic events (MI, stroke, VTE), stratified by sex and baseline characteristics.

Results: SGLT2i initiation was associated with a 5.5% to 5.8% absolute increase in erythrocytosis prevalence compared with DPP-4i and GLP-1RA, with mean hemoglobin and hematocrit increases of 0.37 g/dL and 1.5%, respectively. Male sex, smoking, and empagliflozin (vs. dapagliflozin) were independent risk factors for erythrocytosis. New-onset erythrocytosis was not associated with increased risk of MI, VTE, or stroke (hazard ratios all non-significant).

Source:

Lewis M, et al. (2025, June 23). JAMA Netw Open. Sodium-Glucose Cotransporter 2 Inhibitors, Erythrocytosis, and Thrombosis in Adults With Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/40549381/