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Fadheela Abbas Radhi1*, Marwa Karim2, Afrah Saeed3, Noor Saeed Ali Khamis4, Meaad Abdulhusain
Abdulla5, Hawra Ali Ebrahim Hasan6
Background: Diabetes is a major chronic disease with a growing global burden. Sodium-glucose
cotransporter 2 inhibitors (SGLT2 inhibitors) have demonstrated benefits in glycemic control and
cardiovascular protection. Although real-world studies have assessed SGLT2 inhibitors, evidence
among Bahrainis with type 2 diabetes remains limited.
Objectives: The primary objective was to assess the impact of adding SGLT2 inhibitors on glycemic
control measured by changes in HbA1c. The secondary objective was to evaluate adverse events
associated with SGLT2 inhibitor use.
Methods: This retrospective observational study evaluated the effects of SGLT2 inhibitor therapy on
glycemic control, body weight, blood pressure, and estimated glomerular filtration rate (eGFR) among
patients with type 2 diabetes mellitus (T2DM) attending Central Diabetic Clinics (CDC) in Bahrain.
Data were collected from January to April 2023 and analyzed during 2024-2025.
Results: A total of 282 participants were equally divided into exposed and non-exposed groups and
followed for 32 weeks. At 32 weeks, the exposed group demonstrated significantly greater reductions
in HbA1c and body weight than the non-exposed group (both p < 0.001). Among insulin users, systolic
blood pressure (SBP) decreased significantly more in the exposed group than in the non-exposed
group (p = 0.005). Although eGFR improved in the unadjusted analysis, the association was no longer
statistically significant after adjustment for baseline eGFR (p = 0.143). SGLT2 inhibitor discontinuation
occurred in 13.4% of participants, primarily due to cost, non-adherence, and genitourinary infections.
Conclusion: SGLT2 inhibitor use was associated with significant reductions in HbA1c and body
weight, particularly during the first 16 weeks. Cost and genitourinary infections remain important
barriers to treatment continuation.
Keywords: Type 2 diabetes mellitus; SGLT2 inhibitors; HbA1c; Body weight; Estimated glomerular
filtration rate