SGLT2 Inhibitors Reduce Gout Flares and Medication Use in Type 2 Diabetes: Study

Gout and type 2 diabetes often coincide, making treatment more difficult as drugs treating each condition could aggravate another. For example, diuretics that are prescribed for diabetic comorbidities can increase urate level, whereas nonsteroidal anti-inflammatory drugs and glucocorticoids prescribed in flare-ups of gout can lead to adverse reactions related to kidneys' functions and glycaemia regulation. The authors applied a reliable model called "target trial emulation," allowing to replicate a randomized controlled trial through the application of real-world data collected from the general population registry.

The number of individuals who have been diagnosed both with gout and type 2 diabetes has amounted to 26,739, and their average age has made 66 years. What is more, it should be stressed that almost two-thirds of this sample are under polypharmacy, emphasizing the high-risk character of this target audience. In order to prove the effectiveness of SGLT2is, the scientists used the comparison between patients on SGLT2is and those on DPP-4is as well as GLP-1RAs.

Key findings:

• SGLT2i users had a significantly lower rate of starting this urate-lowering therapy compared to DPP-4i users, with a Hazard Ratio (HR) of 0.62 (95% CI, 0.52–0.73).
• The rate of dispensing high-dose glucocorticoids was reduced, with a Rate Ratio (RR) of 0.78 (95% CI, 0.74–0.83).
• Rates of nonsteroidal anti-inflammatory drug dispensing were lower, showing an RR of 0.85 (95% CI, 0.80–0.92).
• Dispensing rates for colchicine and diuretics were both reduced, with an RR of 0.87 (95% CI, 0.83–0.92 for colchicine; 0.85–0.89 for diuretics).
• The association was notably stronger among patients who were already using diuretics at the start of the study (P for interaction = 0.03).

In summary, this study reveals an innovative solution to manage metabolic and inflammatory disorders synergistically. The SGLT2 inhibitors may be beneficial in minimizing the intake of drugs for gout in patients with coexisting gout and type 2 diabetes. The decrease in the use of medicine will eventually result in fewer negative consequences from NSAIDs and corticosteroids among the high-risk population. SGLT2 agents serve as two-in-one medicines because they reduce allopurinol and acute inflammatory medicines, along with having protective properties for the heart and kidneys. Doctors should be aware of the advantages when selecting glucose-lowering agents among patients with diabetes and gout.

Reference:

Natalie McCormick, Nitzan Burrack, Chio Yokose, Na Lu, Deborah J. Wexler, Sharan K. Rai, Gregory J. Challener, J. Antonio Aviña-Zubieta, Rozalina G. McCoy, Ran Abuhasira, Hyon K. Choi; Gout-Related Medication Use After Initiating Sodium–Glucose Cotransporter 2 Inhibitors in Patients With Gout and Type 2 Diabetes: Population-Based Target Trial Emulation Studies. Diabetes Care 20 February 2026; 49 (3): 460–470. https://doi.org/10.2337/dc25-1713