Hospitalization, ICU admission, and mortality among diabetic patients with inflammatory bowel disease receiving SGLT-2 inhibitors: a retrospective cohort study from the global collaborative network

Background: Patients with coexisting type 2 diabetes mellitus (T2DM) and inflammatory bowel disease (IBD) represent a high-risk population with competing comorbidities, complex medication regimens, and overlapping inflammatory pathways. Although the role of sodium-glucose co-transporter-2 (SGLT2) inhibitors in managing type 2 diabetes is well-established, their impact on outcomes in diabetic patients with coexisting IBD remains unclear. This study aimed to investigate the association between SGLT2i use and hospitalization, intensive care unit (ICU) admission, mortality, IBD-related complications, and surgical procedures in diabetic patients with IBD.

Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Cohort 1 comprised diabetic patients with IBD who received SGLT2 inhibitors with at least three dispensations within one year of IBD diagnosis, and Cohort 2 comprised diabetic patients with IBD never prescribed SGLT2i, matched on baseline characteristics, comorbidities, IBD-specific medications, and laboratory values, yielding 3,950 patients per cohort. Clinical outcomes were evaluated at 1 and 5 years following the index event.

Results: At 1 year, hospitalization, ICU admission, and mortality were significantly lower in Cohort 1 [risk ratio (RR): 0.886, P<0.001; RR: 0.851, P=0.03; and RR: 0.525, P<0.001, respectively]. Kaplan-Meier analysis demonstrated improved survival in Cohort 1 [94.27% vs. 88.76%, P<0.001; hazard ratio (HR): 0.490]. IBD-related complications and surgical procedures were also significantly reduced (RR: 0.879, P=0.004 and RR: 0.548, P=0.02, respectively). At 5 years, hospitalization, ICU admission, and mortality remained significantly lower in Cohort 1 (RR: 0.932, P=0.002; RR: 0.848, P=0.003; and RR: 0.545, P<0.001, respectively). Kaplan-Meier analysis continued to demonstrate improved survival in Cohort 1 (85.01% vs. 74.95%, P<0.001; HR: 0.532), whereas IBD-related complications and surgical procedures were numerically lower but no longer statistically significant (RR: 0.954, P=0.18 and RR: 0.741, P=0.15, respectively).

Conclusions: SGLT2i therapy in diabetic patients with IBD was associated with reduced hospitalization, ICU admission, and mortality, with persistent benefits observed at both 1 and 5 years of follow-up. Reductions in IBD-related complications and surgical procedures were observed, particularly at 1 year. These findings suggest a potential disease-modifying role warranting further prospective investigation.