Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors' conclusion
In a meta-analysis of randomized clinical trials, compared with control, SGLT2 inhibitor use was associated with small statistically significant increases in hemoglobin and hematocrit levels. The clinical significance of these findings is unclear.
Study context
- Population
- Patients with 1 or more of the following conditions: cardiovascular disease, diabetes, heart failure, and chronic kidney diseaseparticipants in 85 randomized clinical trials · Placebo-controlled trials (78) 67,208 · Active-comparator trials (7) 3,335
- Participants
- 70,543 patients
- Comparison
- SGLT2 inhibitor use compared with placebo or active comparator
- Outcome
- Changes in hemoglobin and hematocrit
- Follow-up
- Baseline to
Methodological detailsrandom-effects meta-analysis, randomized, double-masked clinical trials
- Random-effects meta-analysis
- Randomized, double-masked clinical trials
Pooled result
As reported in the abstract
SGLT2 inhibitor group
- Hemoglobin
- 0.55 g/dL (95% CI, 0.49 to 0.61 g/dL; P < .001)
- Hematocrit
- 2.17% (95% CI, 1.95% to 2.39%; P < .001)
Control group
- Hemoglobin
- −0.08 g/dL (95% CI, −0.13 to −0.03 g/dL; P = .003)
- Hematocrit
- −0.13% (95% CI, −0.28% to 0.01%; P = .07)
Hemoglobin
SGLT2 inhibitor group0.55 g/dL (95% CI, 0.49 to 0.61 g/dL; P < .001)
Control group−0.08 g/dL (95% CI, −0.13 to −0.03 g/dL; P = .003)
Hematocrit
SGLT2 inhibitor group2.17% (95% CI, 1.95% to 2.39%; P < .001)
Control group−0.13% (95% CI, −0.28% to 0.01%; P = .07)
SGLT2 inhibitor group vs control groupDifference, g/dL (95% CI)P value
Hemoglobin
0.60(0.55–0.66)
P < 0.001SGLT2 inhibitor group vs control groupDifference (95% CI)P value
Hematocrit
2.36%(2.19%–2.52%)
P < 0.001Further pooled results
mIU/mL
| Outcome | SGLT2 inhibitor group | Control group | Difference (mIU/mL) (95% CI) | P value | |
|---|---|---|---|---|---|
| EPO | 2.35 | 0.04 | 2.11 (0.5–3.71) | P = 0.01 | |
| −2024Difference, mIU/mL (linear scale) |
| Outcome | SGLT2 inhibitor group | Control group | Difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Transferrin saturation | −2.2% | −0.10% | −0.84% (−1.21% to −0.47%) | P < 0.001 | |
| −1.5−1−0.500.5Difference (linear scale) |
Secondary outcomes (red blood cell concentration, erythropoietin (EPO), serum iron, ferritin, transferrin saturation, hepcidin)
- Of the 6 secondary outcomes, 4 showed significant associations with SGLT2 inhibitors
Original publication
Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JAMA. Published 24 October 2026. doi:10.
Summarised from the published abstract; every number is checked against it