Glucosuria linked to better outcomes among patients prescribed SGLT2 inhibitors

A study in the Journal of the American Society of Nephrology evaluated whether routine urinalysis could provide an objective proxy for SGLT2 inhibitor adherence. Researchers used Optum Labs Data Warehouse data from 2014–2023, defining glucosuria as urine glucose of 2+ or greater. One cohort included 3,987 patients tested before and during active prescription fill periods; another included 45,711 prescribed patients tested within six months of treatment initiation.

In the first cohort, SGLT2 inhibitor use was associated with 18.1-fold higher odds of glucosuria (95% CI, 16.4–20.0), adjusted for diabetes status. In the second cohort, 26,657 patients (58%) had glucosuria. Over a mean 3.3 years, after inverse probability of treatment weighting, glucosuria was associated with lower risks of all-cause mortality (HR, 0.78; 95% CI, 0.73–0.83), heart failure hospitalization (HR, 0.87; 95% CI, 0.78–0.98), and end-stage kidney disease (HR, 0.73; 95% CI, 0.58–0.91). Fractures, a negative control outcome, showed no association (HR, 1.00; 95% CI, 0.95–1.06).

These findings support further evaluation of glucosuria as a practical adherence marker. However, this observational analysis does not establish causality or validate absence of glucosuria as proof of non-adherence. Adherence was inferred rather than directly confirmed, and residual confounding remains possible.