Understanding the Link Between SGLT2 Inhibitors, Red Blood Cell Counts, and Blood Clots in Adults With Type 2 Diabetes

Recognizing the Patterns in SGLT2 Utilization and Patient Results

Because sodium glucose cotransporter 2 (SGLT2) inhibitors can lessen kidney and cardiovascular problems, they are frequently used to treat type 2 diabetes. However, new research has shown that erythrocytosis, a disorder in which red blood cell counts increase, affects a small but significant percentage of people.¹ As specialists in pharmaceutical safety, pharmacists are essential in identifying, tracking, and informing patients about these risks.

A recent population-based study of over 76,000 adults with type 2 diabetes found that 6.6% of patients who started SGLT2 inhibitors developed erythrocytosis within 12 months, compared with only 2.4% in those using other glucose-lowering medications.¹

Insights Into Risk Factors and Medication Differences

The study found that men and smokers were significantly more likely to experience this increase in red blood cell counts. In fact, men had more than 4 times the rate of erythrocytosis compared with women. Empagliflozin (Jardiance; Boehringer Ingelheim) users had a higher likelihood of developing the conditions than those on dapagliflozin (Farxiga; AstraZeneca).¹ These distinctions help pharmacists identify patients who may need closer monitoring.

Another study presented at the American Society of Hematology in 2024 confirmed that SGLT2 inhibitors raise erythropoietin levels, suggesting the increase in red blood cells is not due to dehydration but a direct physiological effect.² This reinforces the need for pharmacists to interpret laboratory values with clinical context rather than assuming volume changes alone.

No Evidence of Increase in Blood Clot Risk

The results are encouraging despite worries that erythrocytosis could result in thrombosis. The same JAMA study found no increased risk of venous thromboembolism, heart attack, stroke, or pulmonary embolism in patients taking SGLT2 inhibitors who developed erythrocytosis.¹ A broader review also found no evidence of harm related to clotting in this population.³

Clinical Takeaways

Pharmacists frequently answer patient inquiries, spot lab work trends, and provide adverse effect education. These findings can translate into practice by monitoring lab values, especially hematocrit and hemoglobin in men and smokers. Evaluating medication history and educating patients on the medications is also important, as well as emphasizing the importance of regular checkups.

Conclusion

SGL2 inhibitors continue to offer significant benefits in diabetes management. The initiation of SGLT2 can be associated with a higher risk of new-onset erythrocytosis and an increase in hematocrit and hemoglobin levels. However, erythrocytosis was not linked to a higher risk of thrombotic events. The findings of this study provide reassurance regarding the safety of SGLT2-induced erythrocytosis.¹

REFERENCES

1. Lutsey PL, Hejjaji V, Zelnick LR, et al. Sodium-Glucose Cotransporter 2 Inhibitors, Erythrocytosis, and Thromboembolic Risk in Adults With Type 2 Diabetes. JAMA Netw Open. 2024;7(5):e2414454. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2835466

2. deBoisblanc B, Wong C, Ho JE, et al. Effect of SGLT2 Inhibitors on Erythrocytosis and Erythropoietin in Adults With Type 2 Diabetes. Blood. 2024;144(Suppl 1):5214. https://ashpublications.org/blood/article/144/Supplement%201/5214/526548

3. Gong T, Gu W, Wang X, et al. Cardiovascular and Renal Outcomes Associated With SGLT2 Inhibitors in Patients With Type 2 Diabetes: An Umbrella Review and Meta-analysis. Front Cardiovasc Med. 2024;11:12132679. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12132679/