Analysis of the Relationship Between Plasma and Urinary Glucose and the Significance of Urinary Glucose Levels in Patients Started on SGLT-2 Inhibitors

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Objective: Urinary glucose testing is simple, and has been used as a screening test. However, SGLT-2 inhibitors, drugs for diabetes, which promote massive urinary glucose excretion, are now commercially available, and the number of patients strongly positive for urinary glucose (4+) on health checkups has increased. In this study, we investigated the relationship between the urinary and fasting plasma glucose levels and their changes in persons who had undergone Ningen Dock during 5-year periods before and after SGLT-2 inhibitors became commercially available (2009–2013)(2014–2018).

Methods: The subjects were persons who had undergone health checkups. The fasting blood and urinary glucose levels were measured, and their relationship was investigated.

Results: In the diabetes treatment group, the mean rates of males and females with urinary glucose 4+ among those with a fasting plasma glucose level of <126 mg/dL during the 5 years before SGLT-2 inhibitors became commercially available (launching) were 0.8 and 0%, respectively. However, the percentages 5 years after launching were 25.7 and 16.1%, respectively, showing rapid increases. The specificity, false positive rate, and positive predictive value during the 5 years before launching were 99.4, 0.6, and 53.6%, respectively. The percentages 5 years after launching were 98.5, 1.5, and 21.2%, respectively.

Conclusions: Urinary glucose testing has been used for screening on health checkups. The launching of SGLT-2 inhibitors, which promote massive urinary glucose excretion, markedly influenced the specificity, false positive rate, and positive predictive value of urinary glucose testing.