ArticleRheumatology (Oxford, England)2025
Gout incidence in metformin versus sodium-glucose co-transporter-2 inhibitor users: a retrospective cohort study.
Article in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo compare the incidence of gout in individuals with diabetes receiving metformin vs sodium-glucose co-transporter-2 inhibitors (SGLT-2is).
methodsThis new-user comparative effectiveness study included adults from the JMDC claims database with health check-up and administrative claims data from 2014 to 2022. Individuals initiated on metformin were compared with those initiated on SGLT-2is. The primary outcome was the incidence of new gout diagnoses. After propensity-score inverse probability treatment weighting (IPTW), Cox proportional hazards models were fitted to estimate the hazard ratios (HRs) and 95% CIs. A linear mixed model was employed to assess the association between the two groups and changes in serum uric acid levels.
resultsA total of 21 561 individuals with diabetes were identified, including 17 636 males with a mean age of 53 years. The metformin and SGLT-2i groups included 13 535 and 8026 individuals, respectively. In the metformin and SGLT-2i groups, the gout incidence rates were 2.40 and 3.15 events per 1000 person-years, respectively. After IPTW, metformin was not associated with a decreased risk of gout compared with SGLT-2i (HR 0.90, 95% CI 0.63-1.28; rate difference -0.28, 95% CI -1.24 to 0.68 events per 1000 person-years). The mean difference in serum uric acid level change 1 year after the index date was 0.48 mg/dl (95% CI 0.43-0.52) for the metformin group relative to the SGLT-2i group.
conclusionGout risk may be comparable between metformin and SGLT-2is in individuals with diabetes, with metformin showing a lesser reduction in serum uric acid levels than SGLT-2is.
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