The relationship between SGLT2 inhibitors and hearing loss: a nationwide population-based retrospective cohort study.

ABATRACT: BACKGROUND : Sensorineural hearing loss (SNHL) is a common but underrecognized complication of type 2 diabetes mellitus (T2DM). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) use was associated with favorable renal and cardiovascular outcomes beyond glycemic control, but their impact on auditory outcomes remains unclear. METHODS: We conducted a nationwide cohort study using Taiwan's National Health Insurance Research Database (2000-2021). Patients with T2DM who received SGLT2i for ≥ 90 days were compared with matched non-users. Propensity score matching was applied 1:1 based on demographic, clinical, and treatment characteristics. The primary outcome was the incidence of SNHL, confirmed by audiometric testing. RESULTS: A total of 381,592 patients with type 2 diabetes mellitus (T2DM) were included. Compared with non-users, SGLT2i users exhibited a significantly lower risk of SNHL (adjusted hazard ratios (aHRs) = 0.84; 95% CI: 0.75-0.94). Subgroup analyses confirmed a consistent lower risk across sex, age, urbanization, and comorbidity strata. Notably, long-term SGLT2i use (≥ 366 days) showed a strong dose-response association with reduced SNHL risk (aHR = 0.32; 95% CI: 0.27-0.39). CONCLUSION: SGLT2i use in T2DM patients is associated with a reduced risk of SNHL, particularly with sustained therapy. These findings highlight a potential association between SGLT2i use and a lower risk of auditory complications in diabetes, underscoring the importance of considering hearing health within comprehensive diabetes management.