# Type 2 diabetes, sodium glucose, cotransporter-2 (SGLT2) inhibitors and the vaginal microbiota

> **NIH NIH F31** · UNIVERSITY OF MARYLAND BALTIMORE · 2022 · $36,519

## Abstract

PROJECT SUMMARY
Studies have shown that cisgender women with type 2 diabetes (T2D) are at greater risk for recurrent
urogenital infections, including urinary tract infections and vulvovaginal candidiasis (VVC), but it is unknown
whether individuals with T2D have disproportionately higher rates of bacterial vaginosis (BV). BV is a common
form of vaginitis with a 30% prevalence among North American women. BV is characterized by a
Lactobacillus-deficient vaginal microbiota and is associated with increased risk for sexually transmitted
infections, including HIV, as well as vulvovaginal symptoms that significantly affect quality of life. Sodium
glucose cotransporter-2 (SGLT2) inhibitors, a favorable oral antidiabetic medication, function by inhibiting
reabsorption of glucose in the kidneys, causing increased excretion of glucose in urine. This mechanism has
been associated with increased incidence of VVC, but the influence of SGLT2 inhibitors on the genitourinary
microbiota has not been investigated with molecular methods. In this F31, I propose a molecular epidemiologic
project which assesses the vaginal microbiota associated with T2D and after SGLT2 inhibitor use. I
hypothesize that T2D and SGLT2 inhibitors are associated with molecular-BV and a vaginal microenvironment
low in lactic acid. The production of lactic acid by lactobacilli is an important function because it provides
protection by acidifying the vaginal microenvironment (to pH <4.5). The specific aims are: 1) To assess the
vaginal microenvironment in non-pregnant individuals with T2D compared to ethnicity/race-matched individuals
without T2D. Cisgender women aged 45 years and greater will be recruited to a cross-sectional study at the
University of Maryland Center for Diabetes and Endocrinology and a general health clinic at the Baltimore
Midtown campus. Self-collected vaginal samples will be assessed for bacterial composition utilizing 16S rRNA
gene amplicon sequencing, pan-bacterial quantitative PCR and lactic acid isomer assays. Questionnaires will
collect important covariate information. 2) To compare the genitourinary microbiota of women before and after
treatment with SGLT2 inhibitors, utilizing a repository of urine samples collected from an ongoing study in the
Old Order Amish (R01-DK118942, PI: Taylor, co-sponsor). The single cross-over study design allows for
assessment of changes in the genitourinary microbiota following SGLT2 inhibitors and eliminates confounding
on time-independent factors because it allows each participant to serve as their own control. Aim 2 is based on
repository urine samples, making it highly feasible; recently published studies suggest urine samples
demonstrate high concordance with vaginal microbiota. The studies proposed in this F31 will provide the first
characterization of the vaginal microbiota in the setting of T2D and assess the impact of SGLT2 inhibitors on
the genitourinary microbiota. These findings will contribute to BV screening guidelines ...

## Key facts

- **NIH application ID:** 10462949
- **Project number:** 1F31AI164859-01A1
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Sarah Robbins
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $36,519
- **Award type:** 1
- **Project period:** 2022-05-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10462949

## Citation

> US National Institutes of Health, RePORTER application 10462949, Type 2 diabetes, sodium glucose, cotransporter-2 (SGLT2) inhibitors and the vaginal microbiota (1F31AI164859-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10462949. Licensed CC0.

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