The group of type 2 diabetes drugs known as SGLT2 inhibitors may help reduce the risk for gout — a form of arthritis characterized by sharp pain in a joint, most often in the big toe — according to a new study published in the journal JAMA Network Open.
Gout occurs when structures known as urate crystals build up in the affected joint, causing inflammation and bouts of severe pain. Urate crystals can form when levels of uric acid in your blood are abnormally high — something that can happen when your body produces too much uric acid, or your kidneys don’t excrete enough uric acid into your urine. Uric acid is produced as part of the body’s normal processes, but eating certain foods may also raise uric acid levels. Foods known to contribute to elevated uric acid — and gout — include red meat, organ meats, shrimp, lobster, scallops, and sardines. Longstanding obesity and recent weight gain are also linked to gout.
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For the latest study, researchers were interested in looking at the relationship between SGLT2 inhibitors and gout because of the kidney health benefits these drugs are known to offer. In fact, one SGLT2 inhibitor — Farxiga (dapagliflozin) — was approved in April 2021 in the United States as a treatment for chronic kidney disease, regardless of whether someone has diabetes. While the researchers had every reason to believe that taking these drugs could help improve uric acid excretion in people who might have some level of reduced kidney function, no previous population-wide study had actually confirmed a link between taking these drugs and a lower gout risk.
The researchers looked at data from the Taiwan National Health Institution, which included all people in Taiwan known to have type 2 diabetes between May 2016 and December 2018. They compared outcomes in people who took two different groups of diabetes drugs — SGLT2 inhibitors and DPP-4 inhibitors, which aren’t known to have any kidney benefit. The database included 47,905 people who took an SGLT2 inhibitor and 183,303 who took a DPP-4 inhibitor. The researchers also used this data to create 47,405 pairs of people for analysis — with each pair consisting of one person who took an SGLT2 inhibitor and one who took a DPP-4 inhibitor, but who had otherwise similar traits. The average age of all people in the study was 61.5.
SGLT2 inhibitors linked to lower gout risk
The researchers found that the overall incidence of gout was 20.3 per 1,000 person-years for people who took an SGLT2 inhibitor, and 24.3 per 1,000 person-years for those who took a DPP-4 inhibitor. When comparing similar people based on the matched pairs, the researchers found that taking an SGLT2 inhibitor was linked to an 11% lower risk for gout, compared with taking a DPP-4 inhibitor. This reduction in gout risk from SGLT2 inhibitors appeared to be similar regardless of what other health conditions people had or what other medications they took, but it applied more to people under age 65 — with this younger group seeing a 17% lower risk for gout, compared with younger people who took a DPP-4 inhibitor.
The researchers noted that while these results suggest a gout prevention benefit from taking SGLT2 inhibitors, further studies that look at outcomes over a longer period of time — and, ideally, in diverse populations — should be done to confirm this apparent benefit.
Want to learn more about SGLT2 inhibitors? Read “Diabetes Medicine: SGLT2 Inhibitors.”
