Frontiers in endocrinology · 2026
Wound healing outcomes in diabetic kidney disease patients receiving SGLT2 inhibitor therapy: a prospective propensity score-matched cohort study.
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Zhang Rong-Rong, Huang Siyue, Wang Xinjie, Li Xiaoqin
Аннотация
BACKGROUND: The remarkable cardiorenal benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors have positioned these agents as cornerstone therapies for diabetic kidney disease (DKD). However, theoretical concerns regarding glycosuria-mediated effects on tissue perfusion have left clinicians uncertain about their safety in patients with active wounds. We conducted a prospective cohort study to characterize wound healing outcomes in this vulnerable population.
METHODS: Between January 2018 and December 2023, we prospectively enrolled 247 adults with type 2 diabetes mellitus, estimated glomerular filtration rate (eGFR) of 30-90 mL/min/1.73m², and wounds requiring medical attention at a tertiary wound care center. Participants receiving SGLT2 inhibitors (dapagliflozin, empagliflozin, or canagliflozin) for ≥30 days were matched 1:1 with unexposed controls using propensity scores derived from 15 baseline covariates. The primary endpoint was the time to complete epithelialization; secondary endpoints included wound infection and renal progression at six months.
RESULTS: Following propensity score matching, 204 patients (102 per cohort) with excellent covariate balance (all standardized mean differences <0.10) were analyzed. Wound healing trajectories were virtually identical between the cohorts: median healing time was 33 days (interquartile range [IQR]: 22-52) with SGLT2 inhibitors versus 34 days (24-62) in controls (adjusted hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.82-1.42; p=0.594). No statistically significant difference in infection rates was observed (38.2% vs. 32.4%; unadjusted p=0.464; adjusted p=0.310). During the six-month follow-up period, no renal progression events were observed among SGLT2 inhibitor users (0% vs. 5.9%; p=0.029) and demonstrated superior eGFR preservation (-2.3 ± 3.8 vs. -5.5 ± 4.5 mL/min/1.73m²; p<0.001).
CONCLUSIONS: No evidence of impaired wound healing or increased infection risk was observed with SGLT2 inhibitor therapy in patients with DKD; however, the anticipated nephroprotective benefits were preserved during the six-month follow-up period. These findings argue against the withholding of these beneficial agents in patients with concurrent wounds.
METHODS: Between January 2018 and December 2023, we prospectively enrolled 247 adults with type 2 diabetes mellitus, estimated glomerular filtration rate (eGFR) of 30-90 mL/min/1.73m², and wounds requiring medical attention at a tertiary wound care center. Participants receiving SGLT2 inhibitors (dapagliflozin, empagliflozin, or canagliflozin) for ≥30 days were matched 1:1 with unexposed controls using propensity scores derived from 15 baseline covariates. The primary endpoint was the time to complete epithelialization; secondary endpoints included wound infection and renal progression at six months.
RESULTS: Following propensity score matching, 204 patients (102 per cohort) with excellent covariate balance (all standardized mean differences <0.10) were analyzed. Wound healing trajectories were virtually identical between the cohorts: median healing time was 33 days (interquartile range [IQR]: 22-52) with SGLT2 inhibitors versus 34 days (24-62) in controls (adjusted hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.82-1.42; p=0.594). No statistically significant difference in infection rates was observed (38.2% vs. 32.4%; unadjusted p=0.464; adjusted p=0.310). During the six-month follow-up period, no renal progression events were observed among SGLT2 inhibitor users (0% vs. 5.9%; p=0.029) and demonstrated superior eGFR preservation (-2.3 ± 3.8 vs. -5.5 ± 4.5 mL/min/1.73m²; p<0.001).
CONCLUSIONS: No evidence of impaired wound healing or increased infection risk was observed with SGLT2 inhibitor therapy in patients with DKD; however, the anticipated nephroprotective benefits were preserved during the six-month follow-up period. These findings argue against the withholding of these beneficial agents in patients with concurrent wounds.