Gout commonly coexists with type 2 diabetes mellitus (T2DM) and often requires repeated use of urate-lowering and anti-inflammatory therapies. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) lower serum urate levels, raising interest in whether their use is associated with changes in gout-related medication use in clinical practice. A study published in Diabetes Care used a target trial emulation design to compare gout-related medication use among individuals with gout and T2DM initiating SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is). Glucagon-like peptide 1 receptor agonists (GLP-1RAs) were included as an alternative comparator.

The analysis identified 26,739 adults with gout and T2DM from a general population database. The mean age was 66 years, and 67% had polypharmacy. Cox proportional hazards models and Poisson regression with inverse probability of treatment weighting were used to emulate treatment allocation. The analysis was replicated in an electronic health record dataset with additional adjustment for serum urate and body mass index (BMI).

Compared with DPP-4i initiation, allopurinol initiation was lower among SGLT2i users (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.52-0.73). The association was stronger among individuals using diuretics at baseline (P for interaction = 0.03) and remained consistent when SGLT2is were compared with GLP-1RAs. SGLT2i use was also associated with lower dispensing rates of high-dose glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and diuretics, with rate ratios of 0.78, 0.85, 0.87, and 0.87, respectively.

These findings indicate that SGLT2i use was associated with lower gout-related medication use among individuals with gout and T2DM.