The association between SGLT2 inhibitor use and diabetic peripheral neuropathy in type 2 diabetes: a cross-sectional study

Yuwei Xing, Yishan Yin, Qianqian Zhao

Introduction This study assessed the association between sodium-glucose cotransporter 2 (SGLT2) inhibitor use and the prevalence of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM). Methods We classified 2, 456 individuals with T2DM according to SGLT2 inhibitor treatment status. Propensity score matching (PSM) was implemented as the primary adjustment technique to achieve balance between groups on baseline demographics, laboratory values, comorbidities, and concurrent glucose-lowering agents. Additional propensity score weighting approaches were employed to examine the robustness of our findings, along with subgroup analyses and E-value calculations. Results Among all participants, 399 (16.2%) had received SGLT2 inhibitors. Following PSM, each study arm comprised 398 patients. In the matched cohort, SGLT2 inhibitor use was associated with significantly increased odds of DPN (odds ratio 1.55; 95% confidence interval 1.17–2.05; p = 0.002). This association remained consistent across different propensity score methods, with odds ratios ranging from 1.55 to 1.7 (all p < 0.01). Subgroup analyses confirmed statistical significance, and E-value assessment supported the robustness of the observed effect. Conclusion SGLT2 inhibitor use was associated with a higher prevalence of DPN. Further prospective studies are warranted to establish causality.