Abstract
AIMS/INTRODUCTION: This study aimed to investigate whether the use of sodium-glucose co-transporter 2 inhibitors (SGLT2is) is associated with an increase in hemoglobin in the presence of chronic inflammation. MATERIALS AND METHODS: This is a matched-pair cohort study. Patients with diabetes who visited outpatient clinics from 2019 to 2023 were enrolled. New users and never-users of SGLT2is were matched by propensity scores, separately for those with C-reactive protein (CRP) levels lower than and higher than the median time-averaged CRP. Hemoglobin levels at the last visit for given estimated glomerular filtration rates (eGFR) were estimated using robust regression models with cubic terms of eGFR as covariates. Changes in hemoglobin, CRP, and mean corpuscular volume (MCV) were compared using mixed-effects models. RESULTS: Among 1835 never-users and 690 new users of SGLT2i, 209 and 127 pairs were matched for those with lower and higher time-averaged CRP, respectively. Hemoglobin levels at the last visit were higher among new SGLT2i users, irrespective of CRP levels (P for interaction 0.25). During the first 6 months, hemoglobin increased among new SGLT2i users while it decreased among never-users, and the difference in the trajectories of hemoglobin was more prominent among those with higher time-averaged CRP (P for 3-way interaction 0.02). CRP remained stable irrespective of SGLT2i use and MCV increased among SGLT2i users with higher CRP levels. CONCLUSIONS: SGLT2i use was associated with an increase in hemoglobin levels irrespective of chronic inflammation.