Study shows that sodium-glucose cotransporter-2 inhibitor use is linked to decreased risk for flare in adults with gout and type 2 diabetes

A recent study published in the Annals of Internal Medicine found that sodium-glucose cotransporter-2 inhibitors (SGLT2is) are associated with a decreased risk for recurrent gout flares, gout-related emergency department visits, and gout-related hospitalizations, as well as cardiovascular benefits. 

In a propensity score-matched cohort research, Dr. Natalie McCormick from Massachusetts General Hospital in Boston, and colleagues examined the frequency of gout flares and cardiovascular events in patients with gout and type 2 diabetes who started taking SGLT2is against dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors). Following propensity score matching, there were fewer flares among SGLT2i initiators than among DPP-4i initiators (52.4 vs. 79.7 occurrences per 1000 person-years), with a risk ratio (RR) of 0.66 and a rate difference (RD) of 27.4 per 1000 person-years. For gout-related primary emergency department visits and hospitalizations, the corresponding RR and RD were 0.52 and 3.4 per 1000 person-years, respectively. The corresponding hazard ratio (HR) and RD per 1000 person-years for myocardial infarction and stroke, were 0.69 and 7.6 respectively. The risk of genital infection was increased in those who started taking SGLT2is (HR, 2.15), although the chance of developing osteoarthritis was unaffected (HR, 1.07). Thus, similar results were obtained when propensity score overlaps with weighting was applied. 

In a Taiwan nationwide cohort study conducted in 2021, there was a significant risk reduction in the incidence of gout in 47,405 type 2 diabetes patients who received an SGLT2i compared to 47,405 propensity score-matched individuals who received a DPP-4 inhibitor, especially for patients using dapagliflozin. There were no differences between subgroups in the advantages of SGLT2i treatment for a reduced risk of gout in patients with type 2 diabetes. Similarly, another study in 2022 has also proved that when compared to DPP-4 inhibitor use, SGLT2i use was linked to a lower likelihood of new gout diagnoses. In this investigation, there were 43,201 patients and patients’ median ages ranged from 63.23 years to 71.95 years, and 53.74% of them were male. Gout incidence among SGLT2i users was substantially lower (incidence rate (IR): 2.5) than among DPP4I users (IR: 5.2). After controlling for important demographics, prior comorbidities, medications, and laboratory results, SGLT2i was linked to 51% reduced chances of gout (HR: 0.49; P <0.0001) and 51% lower risks of all-cause mortality (HR: 0.49; P <0.0001). On competing risk and other propensity score techniques, the results were constant. 

These study findings corroborate the potential advantages of incorporating SGLT2is into the treatment regimen for individuals with both gout and type 2 diabetes. By considering the use of SGLT2is in managing gout and type 2 diabetes, clinicians may be able to improve patient outcomes and enhance overall disease management. 

References 

  1. McCormick N, Yokose C, Wei J, Lu N, Wexler DJ, Avina-Zubieta JA, De Vera MA, Zhang Y, Choi HK. Comparative Effectiveness of Sodium–Glucose Cotransporter-2 Inhibitors for Recurrent Gout Flares and Gout-Primary Emergency Department Visits and Hospitalizations: A General Population Cohort Study. Annals of Internal Medicine. 2023 Jul 25. 
  2. Chung MC, Hung PH, Hsiao PJ, Wu LY, Chang CH, Wu MJ, Shieh JJ, Chung CJ. Association of sodium-glucose transport protein 2 inhibitor use for type 2 diabetes and incidence of gout in Taiwan. JAMA network open. 2021 Nov 1;4(11):e2135353-. 
  3. Zhou J, Liu X, Chou OH, Li L, Lee S, Wong WT, Zhang Q, Chang C, Liu T, Tse G, Jing F. Lower risk of gout in sodium glucose cotransporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors in type-2 diabetes. Rheumatology. 2023 Apr 1;62(4):1501-10. 
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