> ## Content Index > Fetch the complete content index at: https://nephspace.com/llms.txt > Use this file to discover other available public pages before exploring further. # Is your patient taking their SGLT2 inhibitor? The urine dipstick may already know - URL: https://nephspace.com/glucosuria-sglt2-adherence/ - Published: 2026-10-02T00:25:00.000Z - Updated: 2026-10-04T19:23:30.000Z - Description: In 45,711 patients newly prescribed an SGLT2 inhibitor, glucose on a routine dipstick went with lower mortality, heart failure hospitalization and kidney failure, while fractures didn't budge. The study is observational, but the check is free. - Author: Dr Wael Hussein - Tags: CKD and cardiometabolic, #story, #has-audio, #research, #full-story, Stories ### The question SGLT2 inhibitors make the kidney spill glucose into the urine. Every routine urinalysis already measures urine glucose. So can a plain dipstick show who is actually taking the drug? And do the patients who test positive do better? ### What they did The NYU team used de-identified US claims and health-record data from the Optum Labs Data Warehouse, covering 2014 to 2023\. Glucosuria meant 2+ or more on the dipstick. First, in 3,987 patients with pharmacy fills, they compared each person's urine before and during treatment. Next, they followed 45,711 people newly prescribed an SGLT2 inhibitor who had a urinalysis within 6 months of starting. Each was classified by that single test. Weighting balanced 41 baseline characteristics between groups. Fractures served as a negative control, an outcome the drug should not change. ### What they found - The marker tracks use. Among patients with negative or trace glucose before treatment, 84% of urinalyses showed 2+ or more while they were filling prescriptions. Active use raised the odds of glucosuria about 11-fold in people with diabetes (OR 10.8; 95% CI 9.8 to 11.9) and 16-fold in those without (OR 16.0; 11.9 to 21.6). - Of the newly prescribed patients, 58% had glucosuria on their first check. - Over a mean of 3.3 years, glucosuria went with lower all-cause mortality (HR 0.78; 0.73 to 0.83), fewer heart failure hospitalizations (HR 0.87; 0.78 to 0.98) and less kidney failure (HR 0.73; 0.58 to 0.91). In absolute terms, deaths ran at 28.9 versus 37.1 per 1,000 person-years. - Fractures did not differ (HR 1.00; 0.95 to 1.06). That is a reassuring negative control, though it cannot fully exclude a "healthy adherer" effect. ### Why it matters Adherence is hard to see in clinic, and this measure costs nothing. A negative dipstick in a patient who is supposed to be on an SGLT2 inhibitor is a prompt to ask a question. The authors conclude that a urinalysis without glucosuria could help identify patients who may need adherence support. The study did not test acting on it. ### What it doesn't prove This is an observational study, so the outcome gaps are associations, not proof that the drug caused them. Patients who take one pill faithfully may take their other heart drugs too. The fracture control can't fully rule that out. Glucosuria is indirect: a negative test may reflect a lack of glucose response rather than a missed dose, and it can't fully separate adherence from high blood sugar. Adherence was judged once and never rechecked. The outcome analysis tracked prescriptions, not fills. No one tested whether acting on the dipstick improves outcomes. Industry ties: Charytan reports consulting for AstraZeneca and other companies and research funding from Boehringer Ingelheim and AstraZeneca. Horwitz reports AstraZeneca consulting. The first and senior authors report none. --- **The source:** Li Z, Surapaneni A, Charytan DM, Horwitz L, Blecker S, Shin J-I, Thorpe LE, Melamed M, Grams ME. Glucosuria as a Marker of Adherence to Sodium-Glucose Cotransporter 2 Inhibitors and Clinical Outcomes in Real-World Practice. J Am Soc Nephrol. Published online ahead of print 2026\. doi:10.1681/ASN.0000001252 [Read the original](https://doi.org/10.1681/ASN.0000001252?ref=nephspace.com) **🎧 Listen:** [Weekly · Oct 2](https://nephspace.com/weekly-oct-2/), from 21:03. *Physician-led, AI-assisted. Dr. Wael Hussein chooses every item NephSpace covers and reviews and edits every story before it is published. The first draft was written in our own words with AI (Claude, by Anthropic) from the full text of the paper and checked against our reading notes; Dr. Hussein then reviewed and edited it. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our* [*disclaimer*](https://nephspace.com/disclaimer/) *and* [*disclosures*](https://nephspace.com/disclosures/)*. Spotted an error?* [*Tell us*](mailto:hello@nephspace.com?subject=Correction)*.*