SGLT2 inhibitors may protect type 2 diabetes patients from gout: JAMA
Taiwan: A recent study in JAMA Network Open has shown that the use of SGLT2 inhibitors in type 2 diabetes (T2D) patients are associated with an 11% lower gout risk compared with the use of DPP4 inhibitors.
Currently, the use of sodium-glucose transport protein 2 (SGLT2) inhibitors is a standard intervention in T2D diabetes patients and in addition also exerts favorable pleiotropic effects to consistently lower blood urate levels. However, to date, no association between SGLT2 inhibitor use and the incidence of gout has been established.
Considering the above, Mu-Chi Chung, Taichung Veterans General Hospital, Taichung, Taiwan, and colleagues aimed to investigate whether prescribed SGLT2 inhibitors are associated with lower gout incidence in patients with T2DM in a cohort study.
For this purpose, the researchers retrospectively analyzed all patients with incident T2DM in Taiwan National Health Institution databases between May 1, 2016, and December 31, 2018. As a comparator, patients using dipeptidyl peptidase 4 (DPP4) inhibitors were included. A total of 47 905 individuals receiving an SGLT2 inhibitor and 183 303 receiving a DPP4 inhibitor were evaluated, along with 47 405 pairs of patients using an SGLT2 inhibitor or DPP4 inhibitor in 1:1 propensity score-matched analyses.
In total, 231 208 patients with T2DM were included in the population; 113 812 individuals (49.22%) were women, and the mean age was 61.53 years.
The study revealed the following findings:
- The overall gout incidence was 20.26 per 1000 patient-years for SGLT2 inhibitor users and 24.30 per 1000 patient-years for DPP4 inhibitor users.
- When potential risk factors were adjusted in the propensity score-matched population, the use of SGLT2 inhibitors was associated with a lower risk of gout (HR, 0.89) compared with DPP4 inhibitors, particularly for patients receiving dapagliflozin (HR, 0.86).
- A sensitivity analysis, performed when a gout diagnosis was ascertained using the ICD-9-CM or ICD-10-CM code with gout-related medication, also showed a significantly lower risk for gout incidence of 15% with SGLT2 inhibitors (HR, 0.85).
- Subgroup analysis indicated that SGLT2 inhibitor benefits in patients with T2DM to achieve a lower gout risk were not different across subgroups.
"The findings of this study suggest that use of SGLT2 inhibitors in patients with T2DM is associated with a lowered gout incidence of 11% compared with DPP4 inhibitors," wrote the authors. "The SGLT2 inhibitors appeared to protect patients with T2DM patients from gout, even across subgroups."
Reference:
Chung M, Hung P, Hsiao P, et al. Association of Sodium-Glucose Transport Protein 2 Inhibitor Use for Type 2 Diabetes and Incidence of Gout in Taiwan. JAMA Netw Open. 2021;4(11):e2135353. doi:10.1001/jamanetworkopen.2021.35353
