SGLT2 Inhibitors Linked With Fewer Gout Flares in Diabetes

Mitchel L. Zoler, PhD 

July 24, 2023


Treatment of adults with type 2 diabetes and gout with a sodium-glucose cotransporter 2 (SGLT2) inhibitor was significantly linked with fewer gout flares compared with matched patients treated with a dipeptidyl peptidase-4 (DPP-4) inhibitor.


  • The study used observational data collected from the entire population of British Columbia, Canada, that included 15,067 adults with both gout and type 2 diabetes in 2014-2020.

  • The group included 8318 patients who initiated an SGLT2 inhibitor and 6749 patients who initiated a DPP-4 inhibitor during the study period after at least 1 year of continuous enrollment.

  • Using propensity-score matching, 4075 matched pairs were identified, where one person initiated an SGLT2 inhibitor and the other started a DPP-4 inhibitor.

  • Primary outcome was recurrent gout flare counts during follow-up that required an emergency department visit, hospital admission, or an outpatient visit for a gout flare coupled with appropriate treatment, tallied from the first day of drug receipt until June 30, 2022, with an average follow-up of 1.6 years.

  • Secondary endpoints included the incidence of myocardial infarction and stroke.


  • Total gout-flare rates after SGLT2 inhibitor initiation were 52.4/1000 person-years and after DPP-4 inhibitor initiation were 79.7/1000 person-years, an adjusted rate ratio of 0.66, a reduction significantly linked with SGLT2 inhibitor use.

  • For flares that required an emergency department visit or hospitalization, initiation of an SGLT2 inhibitor was linked with a significant, reduced adjusted ratio rate of 0.52 compared with DPP-4 inhibitor initiation.

  • The flare-rate reduction linked with SGLT2 inhibitor use was consistent regardless of sex, age, baseline diuretic use, prior treatment with a urate-lowering agent, and baseline gout intensity.

  • SGLT2 inhibitor initiation was also significantly linked with an adjusted reduced hazard ratio of 0.69 in the incidence of myocardial infarction compared with DPP-4 inhibitor initiation, but stroke incidence was not significantly different between the groups.


These findings suggest that SGLT2 inhibitors could have a much-needed ability to simultaneously reduce the burden of recurrent gout flares and coronary sequelae in patients with gout and type 2 diabetes, indicating that "SGLT2 inhibitors may offer distinct benefits," making the drug class "a particularly attractive addition to current urate-lowering therapies," the researchers write.


The study was primarily conducted by researchers at Massachusetts General Hospital in Boston. The study was published online July 24 in Annals of Internal Medicine.


The data used in the study did not include gout flares that did not require medical attention and did not include laboratory findings for study participants. Because the data were observational the findings may be susceptible to unmeasured confounding.


The study received no commercial funding. One author has reported receiving consulting fees from ANI and LG Chem.

Mitchel L. Zoler is a reporter for Medscape and MDedge based in the Philadelphia area. @mitchelzoler

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