Background Hyperuricemia is common in patients with type 2 diabetes mellitus and is known to cause gout. Sodium-glucose cotransporter-2 (SGLT2) inhibitors prevent glucose reabsorption and lower serum uric acid levels. Objective To compare the rate of gout between adults prescribed an SGLT2 inhibitor and those prescribed a glucagon-like peptide-1 (GLP1) receptor agonist. Design Population-based new-user cohort study. Setting A U.S. nationwide commercial insurance database from March 2013 to December 2017. Patients Persons with type 2 diabetes newly prescribed an SGLT2 inhibitor were 1:1 propensity score matched to patients newly prescribed a GLP1 agonist. Persons were excluded if they had a history of gout or had received gout-specific treatment previously. Measurements The primary outcome was a new diagnosis of gout. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of the primary outcome and 95% CIs. Results The study identified 295 907 adults with type 2 diabetes mellitus who were newly prescribed an SGLT2 inhibitor or a GLP1 agonist. The gout incidence rate was lower among patients prescribed an SGLT2 inhibitor (4.9 events per 1000 person-years) than those prescribed a GLP1 agonist (7.8 events per 1000 person-years), with an HR of 0.64 (95% CI, 0.57 to 0.72) and a rate difference of -2.9 (CI, -3.6 to -2.1) per 1000 person-years. Limitation Unmeasured confounding, missing data (namely incomplete laboratory data), and low baseline risk for gout. Conclusion Adults with type 2 diabetes prescribed an SGLT2 inhibitor had a lower rate of gout than those prescribed a GLP1 agonist. Sodium-glucose cotransporter-2 inhibitors may reduce the risk for gout among adults with type 2 diabetes mellitus, although future studies are necessary to confirm this observation. Primary Funding Source Brigham and Women's Hospital.

中文翻译：

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在2型糖尿病患者中评估使用钠-葡萄糖共转运蛋白2抑制剂引起痛风的风险：一项基于人群的队列研究。

背景高尿酸血症在2型糖尿病患者中很常见，并且已知会引起痛风。葡萄糖钠共转运蛋白2（SGLT2）抑制剂可防止葡萄糖重吸收并降低血清尿酸水平。目的比较处方SGLT2抑制剂的成人和服用胰高血糖素样肽-1（GLP1）受体激动剂的成年人的痛风发生率。设计基于人群的新用户队列研究。在2013年3月至2017年12月之间建立美国全国商业保险数据库。患者新开SGLT2抑制剂的2型糖尿病患者与新开GLP1激动剂的患者的1：1倾向得分匹配。如果患者有痛风病史或以前曾接受过痛风治疗，则将其排除在外。测量主要结果是痛风的新诊断。Cox比例风险回归用于估计主要结局和95％CI的风险比（HRs）。结果该研究确定了295907名2型糖尿病成年人，他们新开了SGLT2抑制剂或GLP1激动剂。服用SGLT2抑制剂的患者（每1000人年4.9事件）的痛风发生率低于服用GLP1激动剂的患者（每1000人年7.8事件）的患者HR为0.64（95％CI，0.57至0.72） ），每千人年的比率差异为-2.9（CI，-3.6至-2.1）。局限性不可测的混淆，数据丢失（即实验室数据不完整）以及痛风的基线风险低。结论处方SGLT2抑制剂的2型糖尿病成年人的痛风发生率低于处方GLP1激动剂的成年人。钠-葡萄糖共转运蛋白2抑制剂可能降低2型糖尿病成年人的痛风风险，尽管有必要进行进一步的研究以证实这一发现。布莱根妇女医院的主要资金来源。