Sodium-Glucose Cotransporter-2 Inhibitors vs Sulfonylureas for Gout Prevention Among Patients With Type 2 Diabetes Receiving Metformin
Authors' conclusion
In this population-based cohort study, the gout and cardiovascular benefits associated with SGLT2i in these target trial emulations may guide selection of glucose-lowering therapy in patients with T2D, at risk for or already with gout.
Study context
- Population
- Adults with T2D receiving metformin monotherapy, Canadian general population database, January 1, 2014, to June 30, 2022; 60% male, mean age 60 yearspropensity score matched
- Participants
- 34,604 adults
- Exposure
- SGLT2i vs sulfonylurea added to metformin monotherapy
- Outcome
- Incident gout diagnosis (emergency department (ED), hospital, outpatient and medication dispensing records)
Methodological detailssequential, propensity score-matched, new-user, comparative effectiveness, target trial emulation, 1:1 propensity score matching (primary analysis), overlap weighting (sensitivity analysis), Analysis conducted September to December, 2023
- Sequential
- Propensity score-matched
- New-user
- Comparative effectiveness
- Target trial emulation
- 1:1 propensity score matching (primary analysis)
- Overlap weighting (sensitivity analysis)
- Analysis conducted September to December, 2023
Main finding
As reported in the abstract
Incident gout
SGLT2i
4.27 events per 1000 person-years
Sulfonylurea
6.91 events per 1000 person-years
Each group vs sulfonylureaHazard ratio (95% CI)
SGLT2i
0.62(0.48–0.80)
Each group vs sulfonylureaRate difference, per 1000 person-years (95% CI)
SGLT2i
−2.64(−3.99 to −1.29)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate | |
|---|---|---|
| Recurrent flares among gout patientsSGLT2ivs Sulfonylurea | rate ratio 0.67 (95% CI 0.55–0.82) | |
| MACESGLT2ivs Sulfonylurea | HR 0.87 (95% CI 0.77–0.98) | |
| HF (positive control outcome) | HR 0.53 (95% CI 0.38–0.76) | |
| Osteoarthritis (negative control outcome) | HR 1.11 (95% CI 0.94–1.34) | |
| 0.20.5125Ratio (log scale) |
| Outcome | Rate difference (per 1000 person-years) (95% CI) | |
|---|---|---|
| Recurrent flares among gout patientsSGLT2ivs Sulfonylurea | −20.9 (−31.9 to −10.0) | |
| MACESGLT2ivs Sulfonylurea | −3.58 (−6.19 to −0.96) | |
| −40−20020Difference, per 1000 person-years (linear scale) |
Original publication
Sodium-Glucose Cotransporter-2 Inhibitors vs Sulfonylureas for Gout Prevention Among Patients With Type 2 Diabetes Receiving Metformin. JAMA Intern Med. Published 1 June 2024. doi:10.
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