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Study finds diabetes drug may reduce gout risk

A new study found that sodium-glucose cotransporter-2 (SGLT2) inhibitors might reduce gout risk in adults with type 2 diabetes. The study involved over 200,000 individuals in a US commercial insurance database.

Gout is a painful form of arthritis involving the blood having too much uric acid in it. SGLT2 inhibitors produce glycosuria which causes uric acid to be secreted into the urine and causes uric acid levels in the blood to drop. The study found a 40% risk reduction in gout in adults taking SGLT inhibitors compared to adults prescribed glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 receptor agonists are used for the treatment of type 2 diabetes.

The study says that “SGLT2 inhibitors might be an effective class of medication for the prevention of gout for patients with diabetes or metabolic disorders” if the study’s findings are replicated.

The study involved 119,530 type 2 diabetes patients who were prescribed a SGLT2 inhibitor and an equal number of type 2 diabetes patients who were prescribed a GLP-1 agonist. 486 of the SGLT2 patients developed gout compared to 685 GLP-1 agonist patients developing gout. The results were consistent across sex, baseline diuretic use and age.

Individuals with gout history were excluded. The study’s authors say this means that “subsequent observational studies in patients with prevalent gout and in those with a higher baseline risk for gout (such as those older than 65 years and those with established cardiovascular disease) will be particularly important to determine whether the magnitude of potential benefit we identified represents an underestimate.”

The study’s authors note that SGLT inhibitors come with known risks. These risks include diabetic ketoacidosis, genital infections and lower-limb amputation.

The study’s authors point out that new gout treatments are required since a study found a link between febuxostat and an increased risk of death from cardiovascular or heart-related causes. Febuxostat is sold as Uloric for the treatment of gout.

“Gout is the most common form of inflammatory arthritis and adults with diabetes are at particularly high risk,” said Michael Fralick, MD, one of the study’s authors. “Identifying medications that reduce this risk is important, especially since one commonly used medication for gout — febuxostat [Uloric] — was recently found to increase a person’s risk of death.”

SGLT inhibitors have other uses besides glucose lowering and, potentially, gout prevention. The FDA recently approved the SGLT-2 inhibitor canagliflozin for renal and cardiovascular preventions.

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John Elliot

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