SGLT2 inhibitors might protect diabetes patients from gout

USA: Hyperuricemia, known to cause gout, is common in patients with type 2 diabetes (T2D). Now, a recent study has found that prescribing a sodium-glucose cotransporter-2 (SGLT2) inhibitor to T2D patients might protect them from gout.

According to the study, published in the Annals of Internal Medicine, T2D patients prescribed an SGLT2 inhibitor had a lower risk of gout compared to those prescribed a glucagon-like peptide-1 (GLP1) agonist.

Hyperuricemia, excess of uric acid in the blood, is common in type 2 diabetes patients and is known to cause gout. Exercise and diet can prevent gout but many patients require long-term pharmacologic therapy. SGLT2 inhibitors are known to prevent glucose reabsorption and lower the levels of serum uric acid.

Michael Fralick, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, and colleagues conducted this population-based new-user cohort study to compare the rate of gout between adults prescribed an SGLT2 inhibitor and those prescribed a glucagon-like peptide-1 (GLP1) receptor, an agonist.

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For the purpose, the researchers studied a U.S. nationwide commercial insurance database from March 2013 to December 2017. The study involved 295 907 adults with type 2 diabetes mellitus who have newly prescribed an SGLT2 inhibitor or a GLP1 agonist. People were excluded if they had a history of gout or had received gout-specific treatment previously.

The primary outcome was a new diagnosis of gout.

The researchers found that the gout incidence rate was lower among patients prescribed an SGLT2 inhibitor (4.9 events per 1000 person-years) than those prescribed a GLP1 agonist (7.8 events per 1000 person-years), with an HR of 0.64.

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"Future studies are necessary to confirm the findings," concluded the authors.

The study, "Assessing the Risk for Gout With Sodium–Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Population-Based Cohort Study," is published in the journal Annals of Internal Medicine.

DOI: 10.7326/M19-2610