JAMA Netw Open

SGLT2 inhibitors linked to increased erythrocytosis but not higher thrombotic risk

July 1, 2025

While SGLT2 inhibitors increase erythrocytosis risk, this doesn’t appear to translate into elevated thrombotic risk.

Study details: This retrospective cohort study analyzed over 100,000 adults with type 2 DM initiating SGLT2 inhibitors, comparing them to matched cohorts on DPP-4 inhibitors or GLP-1 RAs. Primary outcomes were incidence of erythrocytosis and thrombotic events (MI, stroke, VTE), stratified by sex and baseline characteristics.

Results: SGLT2i initiation was associated with a 5.5% to 5.8% absolute increase in erythrocytosis prevalence compared with DPP-4i and GLP-1RA, with mean hemoglobin and hematocrit increases of 0.37 g/dL and 1.5%, respectively. Male sex, smoking, and empagliflozin (vs. dapagliflozin) were independent risk factors for erythrocytosis. New-onset erythrocytosis was not associated with increased risk of MI, VTE, or stroke (hazard ratios all non-significant).

Source:

Lewis M, et al. (2025, June 23). JAMA Netw Open. Sodium-Glucose Cotransporter 2 Inhibitors, Erythrocytosis, and Thrombosis in Adults With Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/40549381/