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Do SGLT2 Inhibitors Affect Anxiety and Insomnia Risk Compared to Other Diabetes Drugs?

RPEP-149612026Chang, Chen-I; Lin, Jun-Fu; Chen, I-Chieh; Lin, Ching-Heng; Chen, Hsin-Hua; Chang, Ming-Hong; Tang, Chien-Lun; Pai, Yen-Wei
evidence
The takeaway

A large retrospective study compared SGLT2 inhibitors with other diabetes drug classes for risk of developing anxiety and insomnia in type 2 diabetes patients.

Anxiety + insomnia risk compared

SGLT2 inhibitors versus other diabetes drug classes in TriNetX US database

What the researchers found

The study compared incident anxiety and insomnia rates between SGLT2 inhibitor users and other antihyperglycemic agent users in type 2 diabetes, providing comparative mental health safety data.

Why it matters

Diabetes patients have higher rates of anxiety and insomnia. Knowing which diabetes medications help versus worsen mental health can guide treatment choices for patients dealing with both conditions.

How the study worked

Retrospective, active-comparator, multicenter cohort study using TriNetX US Collaborative Network data.

What this study cannot tell us

Retrospective observational design cannot prove causation; potential confounding despite matching; database may not capture all anxiety/insomnia diagnoses.

How to read the evidence

Large retrospective cohort study with active comparators — provides real-world evidence but cannot establish causation.

When this study was published

Published in 2026, addressing emerging questions about mental health effects of newer diabetes medications.

The bigger picture

As diabetes management increasingly considers whole-patient health rather than just blood sugar, understanding psychiatric side effects of metabolic drugs becomes essential for shared decision-making.

Questions still open

  • What mechanism might explain differences in mental health outcomes between diabetes drug classes?
  • Should mental health history influence which diabetes medication a patient is prescribed?

Common questions

Can diabetes medications affect mental health?
Growing evidence suggests different diabetes drug classes may have varying effects on anxiety, depression, and sleep. This study specifically examined whether SGLT2 inhibitors affect anxiety and insomnia risk.
What are SGLT2 inhibitors?
SGLT2 inhibitors (like empagliflozin, dapagliflozin) are diabetes drugs that work by causing the kidneys to excrete excess glucose in urine, lowering blood sugar and providing cardiovascular and kidney protection.

Read the original research

Association of sodium-glucose cotransporter 2 inhibitors with the risk of incident anxiety and insomnia: a retrospective cohort study using the TriNetX database.

Diabetes & metabolic syndrome, 20(1), 103373

View on PubMed ↗Publisher’s paper ↗

Citation

Chang, Chen-I; Lin, Jun-Fu; Chen, I-Chieh; Lin, Ching-Heng; Chen, Hsin-Hua; Chang, Ming-Hong; Tang, Chien-Lun; Pai, Yen-Wei. (2026). Association of sodium-glucose cotransporter 2 inhibitors with the risk of incident anxiety and insomnia: a retrospective cohort study using the TriNetX database.. Diabetes & metabolic syndrome, 20(1), 103373. https://doi.org/10.1016/j.dsx.2025.103373