For People with Diabetes, Starting an SGLT2 Inhibitor Could Lower Gout Risk

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An analysis of more than 20,000 people with type 2 diabetes suggests initiating therapy with an SGLT2 inhibitor, as a second-line treatment to metformin, was associated with a lower risk of developing gout relative to other second-line therapies.

Use of SGLT2 inhibitors and metformin could significantly reduce risk of developing incident gout among people with type 2 diabetes, according to a new study from the European Congress on Rheumatology (EULAR) 2023.

As the burden of type 2 diabetes has ballooned in the US and abroad, the SGLT2 inhibitor class has rose to prominence after revelations of its cardiorenal protective benefits were elucidated in multiple phase 3 trials. As a result, clinicians across multiple specialties have taken part in and driven implementation efforts to increase usage.2

Citing a potential serum urate-lowering effect within some of the aforementioned trials, investigators sought to assess and compare incident gout risk among metformin-treated patients with type 2 diabetes initiating treatment with an SGLT2 inhibitor relative to their counterparts using other second-line type 2 diabetes medications, including GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas. With this in mind, investigators designed their research endeavor as a new-user, active competitor, population-based cohort study leveraging data form an administrative health database containing information related to residents of British Columbia, Canada.1

The specific period of interest for the study was January 2014-June 2022. Of note, investigators included all dispensed prescriptions in their study, regardless of funder. For the purpose of analysis, adult patients with type 2 diabetes using metformin were identified using ICD codes and dispensing data.1

The primary outcome of interest for the study was incident gout, which investigators defined as inpatient or outpatient diagnosis of gout plus dispensing of a gout medication within 14 days. Investigators pointed out analyses were stratified by sex, age, and baseline diuretic use. For the purpose of analysis, investigators used Cox proportional hazards models with propensity score overlap weighting to assess risk for the primary outcome.1

Upon analysis, results indicated SGLT2 inhibitor initiation was associated with a reduced risk of gout compared to DPP-4 inhibitor use (Hazard ratio [HR], 0.54 [95% Confidence interval [CI], 0.39-0.74]), compared to GLP-1 receptor agonist use (HR, 0.39 [95% CI, 0.24-0.64]), and compared to sulfonylurea use (HR, 0.61 [95% CI, 0.46-0.80]). Investigators pointed out these results were consistent regardless of sex, age, or baseline diuretic use.1

With an interest in learning more about the impact of SGLT2 inhibitor use on risk of incident gout, our editorial team sat down with study presenter Natalie McCormick, PhD, of Massachusetts General Hospital and Harvard Medical School, to learn more.

Dr. McCormick has no relevant disclosures to report.

References:

  1. Yokose C, McCormick N, Lu L, Wei J, Zhang Y, Choi H. RISK OF INCIDENT GOUT ASSOCIATED WITH INITIATION OF SODIUM-GLUCOSE COTRANSPORTER-2 INHIBITORS VERSUS OTHER SECOND-LINE AGENTS AMONG METFORMIN USERS WITH TYPE 2 DIABETES. Paper presented at: European Congress of Rheumatology (EULAR) 2023. Milan, Italy. May 31 – June 3, 2023.
  2. Campbell P, Iapoce C. 10 years of SGLT2 inhibitors: A Decade of Redefining Cardiometabolic Care. HCP Live. March 29, 2023. Accessed June 2, 2023. https://www.hcplive.com/view/10-years-of-sglt2-inhibitors-a-decade-of-redefining-cardiometabolic-care.
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