SGLT2 Inhibitors May Lower Risk of Atopic Dermatitis in Diabetics: Study
Researchers have identified in a new study that sodium-glucose cotransporter-2 inhibitors (SGLT2i) could diminish the risk for the development of atopic dermatitis (AD) in patients with type 2 diabetes. Atopic dermatitis, characterized as a metabolic inflammatory skin condition, is recognized to have associations with the metabolic syndrome. Given SGLT2i’s ability to promote glucose and sodium excretion through urine, their impact on skin conditions has gained interest. The study was published in The British Journal of Dermatology by Yuan-Liang and colleagues.
https://doi.org/10.1093/bjd/ljaf086
This nationwide, active-comparator cohort study used data from the Taiwan National Health Insurance Database. Adult type 2 diabetes patients who started either SGLT2i or DPP4i between May 2016 and December 2018 were included, as long as they had no previous prescriptions for these drugs in the 12 months prior to recruitment. The study group consisted of 148,354 SGLT2i users, and the comparator group consisted of 322,703 DPP4i users. The main outcome was AD incidence, which was measured with Cox proportional hazards regression models. To control for confounders, inverse probability of treatment weighting (IPTW) was used to balance variables like baseline parameters, medical history, and prior medication use. Other analyses, such as sensitivity tests, subgroup analysis, and gender analysis, were also carried out for cross-validation.
Key Findings
•Reduced Rate of AD: The incidence of AD in SGLT2i users was 9.742 per 1,000 person-years and in DPP4i users was 12.070 per 1,000 person-years.
• Substantial Risk Reduction: SGLT2i users, after IPTW adjustment, presented with a 16% lower risk of AD compared to DPP4i users (HR = 0.847).
• Persistent Protective Effect: All SGLT2i classes experienced a persistent reduced risk for AD.
• Dose-Dependent Benefit: The highest dose of SGLT2i was linked with the lowest AD risk (IPTW-adjusted HR = 0.647), which lends support to a hypothetical dose-response relationship.
• Gender Differences: Male SGLT2i users exhibited a greater protective effect against AD (IPTW-adjusted HR = 0.750) compared to female users.
The research implies several mechanisms through which SGLT2i could decrease AD risk. Through glucose excretion, these drugs could decrease systemic inflammation, a central mechanism in AD pathogenesis. The sodium loss caused by SGLT2i could have immunomodulatory effects, perhaps affecting skin barrier function and inflammatory processes.
The study authors concluded that SGLT2i markedly decreases AD risk in patients with diabetes versus DPP4i, and the highest efficacy is achieved at higher doses. These findings confirm that SGLT2i can be utilized not only to manage diabetes but also as a measure to prevent AD, especially in men. More research should investigate the mechanisms and long-term skin effects of SGLT2i.
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