Certain Diabetes Meds May Lower Gout Risk, Too
Medications called SGLT2 inhibitors lower blood sugar in people with type 2 diabetes. And new research suggests these drugs may have an added benefit -- lowering the risk of gout.
Compared with people taking another class of diabetes drugs (GLP1 receptor agonists), those taking the SGLT2 drugs had 36% reduced odds of developing gout, the painful condition that usually starts in the foot.
"SGLT2s are one of the most effective classes of medications for people with type 2 diabetes, and they might also reduce risk of gout," said study lead author Dr. Michael Fralick, a general internist at the University of Toronto.
SGLT2 inhibitors are a newer class of prescription medicines for use in adults with type 2 diabetes, according to the U.S. Food and Drug Administration. These medications make the kidneys remove sugar from the body through the urine. Drugs in the SGLT2 inhibitor class include canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
People with type 2 diabetes often have too much of a substance called uric acid in their blood. Crystals from uric acid can build up in your joints, causing gout, the authors said in background notes.
Gout is a type of arthritis that affects millions of Americans, according to the U.S. National Institute of Arthritis and Musculoskeletal Diseases.
Gout symptoms often first appear in the big toe. Symptoms can include intense joint pain and swelling.
SGLT2 inhibitors aren't without risk. The FDA has required warnings about potential low bone density and an increased risk of fractures for people taking these drugs. The FDA has also found a higher risk of serious infections and lower limb amputations.
Almost 300,000 adults with type 2 diabetes were included in the study. Their average age was 54. All had recently been prescribed an SGLT2 inhibitor, or a GLP1 receptor agonist, drugs from another new class of diabetes medications that include dulaglutide (Trulicity), liraglutide (Victoza), exenatide (Byetta), and semaglutide (Ozempic).
Of the nearly 152,000 adults taking an SGLT2 inhibitor, 636 developed gout. In the almost 144,000 people taking a GLP1, 836 developed gout, the study found.
Dr. Barbara Keber is vice chair of family medicine at Northwell Health in Glen Cove, N.Y. She reviewed the study and noted that it had some limitations, but it was large and well-controlled.
"The results revealed a difference in the patients who developed gout between the two groups, which is significant," Keber said.
There aren't other similar studies for comparison, however. "More studies need to be performed before this can be translated into clinical practice for use in reduction of gout in high-risk patients," she said.
Study author Fralick said, "With every person I see with type 2 diabetes, I'm always weighing the risks and benefits and costs of a drug. These drugs [SGLT2s] are very expensive. But SGLT2 inhibitors don't lead to hypoglycemia [low blood sugar] and don't cause weight gain. And among individuals who have gout or have an increased risk of gout, these data suggest that SGLT2 inhibitors could reduce their risk."
Fralick worked at Brigham and Women's Hospital in Boston in the division of pharmacoepidemiology and pharmacoeconomics when the study was conducted.
Dr. James Trapasso, an internal medicine physician at New York-Presbyterian Medical Group Hudson Valley, is a fan of SGLT2 inhibitors. He was not part of the study but also reviewed the findings.
"This class of medicine is one of my favorites for type 2 diabetes. The possibility of gout reduction or prevention is icing on the cake. It's always nice to have another reason to use a drug," Trapasso said.
The study findings were published Jan. 13 in the Annals of Internal Medicine. Brigham and Women's Hospital funded the study.
Learn more about gout from the U.S. National Institute of Arthritis and Musculoskeletal Diseases.
SOURCES: Michael Fralick, M.D., Ph.D., general internist, University of Toronto, Canada; Barbara Keber, M.D., vice chair, department of family medicine, Northwell Health, Glen Cove, N.Y.; James Trapasso, M.D., internal medicine physician, New York-Presbyterian Medical Group Hudson Valley, N.Y.; Jan. 13, 2020, Annals of Internal Medicine