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SGLT2 in Patients With Type 2 Diabetes Lowers Risk of Gout

This study was published in Preprints With The Lancet and has not yet been peer reviewed.

Key Takeaways

  • Patients with type 2 diabetes treated with a sodium-glucose cotransporter 2 (SGLT2) inhibitor had significantly lower rates of gout and all-cause mortality when compared with patients treated with a dipeptidyl peptidase-4 (DPP-4) inhibitor in a retrospective analysis of more than 60,000 patients using propensity-score matching and multiple adjustments for potential confounders.

  • The significant association persisted regardless of type of SGLT2 inhibitor and was consistent across sex and various subgroups.

Why This Matters

  • The authors said that, as far as they know, this is the first study to analyze the long-term effects of SGLT2 and DPP-4 inhibitors on the incidence of gout in people with type 2 diabetes.

  • The authors hypothesized that SGLT2 inhibitors might reduce the risks of gout through its renal protective effects.

Study Design

  • A retrospective, territory-wide (Hong Kong) cohort study of 60,996 people with type 2 diabetes treated with an SGLT2 or DPP-4 inhibitor during January 2015 through December 2020 and followed through December 2020 or until death.

  • Median follow-up was 5.6 years and the analysis excluded those who received both an SGLT2 and DPP-4 inhibitor. A little over a third of participants received an SGLT2 inhibitor and about two thirds received a DDP4 inhibitor.

  • Propensity-score matching reduced the study cohort by about one third. The matched cohort had a 2.5% incidence of new-onset gout and about 5% mortality during follow-up.

Key Results

  • During a median 5.6-year follow-up, treatment with an SGLT2 inhibitor was associated with a 54% (P < .0001) lower rate of incident gout and a 62% (P < .0001) lower rate of all-cause mortality compared with DDP4 inhibitors in propensity-score matched groups in a multivariable Cox analysis, after adjustment for significant demographics, past comorbidities, other drug use, and subclinical biomarkers.


  • As an observational study, the report has an inherent information bias due to under-coding, coding errors, missing data, the uncontrolled duration of drug exposure, and unknown medication adherence.

  • Despite propensity-score matching, confounding factors may have persisted. Several important lifestyle risk factors and laboratory results for gout, such as body mass index and blood uric acid level, were not available.

  • The study did not include gout episodes that occurred outside of public hospitals, but the severe pain caused by gout likely prompted patients having acute gout attacks to seek care at public hospitals.

  • The retrospective study design means the authors can infer associations but cannot prove causal links between incident gout and use of agents from either SGLT2 inhibitor or DPP-4 inhibitor classes.


  • The study received no commercial funding.

  • None of the authors had disclosures.

This is a summary of a preprint research study, “Lower risk of gout in sodium glucose cotransporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors in type-2 diabetes patients: A propensity score-matched study with competing risk analysis” written by researchers primarily at several centers in the Hong Kong region of China. It has been published on Preprints With The Lancet and is provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found here.

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