Review links diabetes drugs to higher blood counts
The analysis found higher hemoglobin and hematocrit, while the clinical meaning and possible clotting risk remain uncertain.
High evidenceReviewSome caution advised
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
Researchers combined results from 10 studies examining whether SGLT2 inhibitors—medicines used by adults with type 2 diabetes—change hemoglobin and hematocrit, measures related to red blood cells. The studies included randomized and observational research and followed participants for 8 weeks to 24 months.
Across the randomized studies, the medicines were associated with higher hemoglobin and hematocrit than placebo. Real-world data also reported more cases classified as polycythemia, or an unusually high red-blood-cell level. The review found limited information about blood-clotting events and said larger, longer prospective studies are needed to clarify their significance.
The question reviewed
The researchers conducted a PRISMA-based systematic review and meta-analysis of studies available in PubMed, Scopus, and Embase through February 2026. They examined adults with type 2 diabetes taking SGLT2 inhibitors and assessed changes in hemoglobin and hematocrit, as well as reports of erythrocytosis or polycythemia and thrombotic events. Ten randomized and observational studies were included. The methods state that people with primary polycythemia, end-stage renal disease, or heart failure were excluded, although the abstract's conclusion describes findings in people with some of these conditions; the applicable population is therefore not completely clear.
Key conclusions
In three randomized controlled trials involving 171 patients, SGLT2 inhibitors were associated with a 2.29 percentage-point higher hematocrit than placebo, with a 95% confidence interval of 1.48 to 3.09 percentage points. Hemoglobin was 0.51 g/dL higher, with a 95% confidence interval of 0.28 to 0.74 g/dL. The included medicines were empagliflozin, dapagliflozin, and canagliflozin. Real-world data covering 9,646 patients reported polycythemia prevalence increasing from 2.4% to 9.7%, with severe cases reported in 1.4% of patients. One observational study of 100 people with JAK2-unmutated erythrocytosis reported thrombotic events in 10%; this small observational result cannot determine whether SGLT2 inhibitors caused those events. The abstract reports that blood-count changes appeared early and seemed reversible after the drug was stopped, but the supporting study details are not provided.
Where this may apply
The findings are most relevant to adults with type 2 diabetes who are similar to participants in the included studies. The methods say people with primary polycythemia, end-stage kidney disease, or heart failure were excluded, although the abstract's conclusion refers to people with those conditions; this inconsistency makes applicability to those groups unknown. The review does not establish what the findings mean for people without type 2 diabetes.
The significance
SGLT2 inhibitors were consistently associated with higher hemoglobin and hematocrit in the studies reviewed. A subset of patients may therefore develop clinically significant erythrocytosis, but the review does not establish how often this leads to health problems or whether the medicines increase clotting risk. The findings may be relevant to discussions of blood-count changes in adults with type 2 diabetes, while their meaning for people with excluded or differently represented conditions remains uncertain. This review does not by itself show that the observed changes cause harm or benefit in any individual person.
Limitations & evidence assessment
The review included only 10 studies, with follow-up ranging from 8 weeks to 24 months, so longer-term effects are not well established. The studies included both randomized and observational designs, and the reported increase in polycythemia came from real-world data, which can be affected by differences between treated and untreated groups. Evidence about clotting events was limited to one observational study of 100 people with JAK2-unmutated erythrocytosis. The abstract does not provide enough detail about the individual studies, and it contains an inconsistency: the methods say people with end-stage kidney disease or heart failure were excluded, while the conclusion refers to those groups.
Why this evidence level: Meta-analysis pooling multiple studies sits at the top of common evidence hierarchies.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
// Source
European Journal of Clinical Pharmacology · 2026 · DOI: 10.1007/s00228-026-04160-1
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