Experience of dapagliflozin use in elderly female patients with hyperactive urinary bladder

Abstract. Hyperactive urinary bladder (HAUB) is common in type 2 diabetes mellitus (T2DM) and may be a factor limiting use of sodium-glucose co-transporter 2 inhibitors (SGLT2). Current studies demonstrate an increased risk of urinary tract infections (UTIs) development during SGLT2 therapy, which may be facilitated by HAUB.

The aim: to evaluate the effect of dapagliflozin therapy at HAUB clinical course in T2DM female patients and possibilities of using herbal uroseptic containing extracts of centaury herb, lovage roots and rosemary leaves for recurrent UTIs’ development prevention.

Material and methods. An outpatient examination of 18 female patients with T2DM and HAUB was carried out. The median age of the patients was 72 (68–79) years. Dapagliflozin at a dose of 10 mg was selected from SGLT2; it was added to the existing glucose-lowering therapy. Follow-up questionnaire, general urine analysis were performed after 1 and 3 months, and urination diaries were assessed after a month of SGLT-2 use.

Results. Initially, 11 patients had a mild degree of urinary disorder, and 7 had a moderate degree. A month later, during SNGLT-2 therapy, mild severity of urinary disorder took place in 8, moderate – in 4, severe – in 6 female participants of the study. There was a significantly valid increase in urination frequency, minimum and maximum urine volumes. In 7 female patients with initially moderate degree of urinary disturbances, a deterioration in HAUB clinical course was recorded, which was facilitated by urinary tract infection. Asymptomatic bacteriuria was detected in 7 out of 11 females with initially mild urinary disorder. After antibiotic therapy for complicated cystitis and asymptomatic bacteriuria, 14 patients continued taking dapagliflozin. Additionally, monthly administration of a herbal uroseptic for 10 days was recommended. Follow-up examination after 3 months showed no worsening of HAUB.

Conclusion. Taking SGLT-2 inhibitors in elderly female patients with T2DM and HAUB increases the risk of developing urinary tract infections. For patients with mild urinary disorders receiving gliflozin, it is advisable to recommend an uroseptic containing extracts of centaury herb, lovage roots and rosemary leaves for 10 days of each month. In case of moderate to severe HAUB, it is preferable to use incretins.