This study investigated the correlation between the use of sodium–glucose cotransporter-2 inhibitors (SGLT2is) and the risk of urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (T2DM), using data from the National Health Insurance Service (NHIS) of South Korea.

This retrospective, population-based cohort study was conducted using NHIS data. Patients diagnosed with T2DM and already receiving metformin therapy were administered either SGLT2is or other antidiabetic agents as part of a dual-therapy regimen. The incidence of UTIs was measured and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Kaplan–Meier survival analysis was performed to estimate the cumulative incidence of UTIs.

This study included 27,128 patients, of whom 1,274 were treated with SGLT2is. The HR for the incidence of UTIs in SGLT2i users compared to the control group was 0.874 (95% CI: 0.585–1.309, p = 0.5097), indicating no statistically significant increase in UTI risk among SGLT2i users. Kaplan–Meier analysis showed no significant difference in the incidence of UTIs between the groups.

In this large, population-based cohort study, the use of SGLT2is was not associated with a statistically significant increase in the risk of UTIs. Although SGLT2i use is linked to increased glucose excretion in the urine, this study indicates that the clinical impact on UTI risk is minimal. Overall, continuous monitoring and patient education regarding UTI symptoms remain important in clinical practice.