SGLT2 Inhibitors Linked to Lower Anemia Risk in Type 2 Diabetes, Suggests Study
Germany: Researchers have found in a new study of 28,441 patients with type 2 diabetes that SGLT2 inhibitors were associated with a 33% reduced risk of iron deficiency anaemia compared to DPP-4 inhibitors. Further, the protective effect was more significant in men and in patients aged 61 and older.
The study, published in Diabetes, Obesity and Metabolism, was conducted by Dr. Theresia Sarabhai and Dr. Karel Kostev in Germany. It explored whether sodium–glucose cotransporter-2 inhibitors (SGLT2i), a class of drugs widely used for type 2 diabetes, influence the risk of developing iron deficiency anemia (IDA), a frequent comorbidity in this patient population. Previous research has suggested that SGLT2 inhibitors may affect erythropoiesis and iron metabolism, but clear clinical evidence has been lacking.
To address this, the researchers carried out a retrospective cohort study using data from the German IQVIA Disease Analyzer, a database of electronic medical records from office-based practices. Eligible participants were adults with type 2 diabetes who started therapy with either SGLT2 inhibitors or dipeptidyl peptidase-4 inhibitors (DPP-4i) between 2012 and 2022, in combination with metformin. Patients with prior diagnoses of anaemia were excluded.
Propensity score matching was applied to ensure comparability between groups based on age, sex, baseline HbA1c levels, metformin duration, and anemia-related comorbidities. This yielded 28,441 patients in each cohort, with a mean age of 64.3 years and 36.5% women. Follow-up extended for up to five years or until a diagnosis of IDA, a change in antidiabetic therapy, loss to follow-up, or study end.
The study led to the following findings:
- The 5-year cumulative incidence of iron deficiency anaemia was 6.9% in the SGLT2 inhibitor group compared with 11.3% in the DPP-4 inhibitor group.
- SGLT2 inhibitor therapy was linked to a 33% lower risk of iron deficiency anaemia (HR, 0.67).
- The protective effect was stronger in men than in women.
- Patients aged over 60 years showed a significant benefit.
- Among men aged 51–70 years, the protective effect was most pronounced.
- The benefit of SGLT2 inhibitors was seen mainly in patients with shorter durations of metformin use (less than three years).
The authors noted that these results highlight potential hematologic benefits of SGLT2 inhibitors, beyond their established role in glycaemic control and cardiovascular protection. “These data highlight a favorable effect on iron homeostasis, particularly in selected subgroups,” they wrote.
However, the study has limitations. As an observational analysis, it cannot establish causation. Other factors, such as socioeconomic status, were not assessed, and the absence of laboratory-confirmed anemia markers may have led to underdiagnosis. Over-the-counter supplementation with iron, vitamin B12, or folate was also not captured in the dataset.
"Despite these constraints, the findings add to real-world evidence supporting a broader role for SGLT2 inhibitors in managing complications of type 2 diabetes. The association with a lower incidence of iron deficiency anaemia, especially among older men, warrants further investigation in randomized clinical trials to determine whether these benefits translate into improved patient outcomes," the authors concluded.
Reference:
Sarabhai T, Kostev K. SGLT2 inhibitor therapy and lower incidence of iron deficiency anaemia in patients with type 2 diabetes: A retrospective cohort study from Germany. Diabetes Obes Metab. 2025 Aug 22. doi: 10.1111/dom.70057. Epub ahead of print. PMID: 40843651.
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