{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:38:50Z","timestamp":1791851930145,"version":"4.3.4"},"reference-count":68,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:sec id=\"ab-ioi240011-4\"><jats:title>Importance<\/jats:title><jats:p>Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are a revolutionary treatment for type 2 diabetes (T2D) with cardiovascular, kidney, and serum urate-lowering benefits.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240011-5\"><jats:title>Objective<\/jats:title><jats:p>To compare risk of incident gout and rate of recurrent flares between patients with T2D initiating SGLT2i vs sulfonylurea, most common second-line glucose-lowering therapy, when added to metformin monotherapy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240011-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This sequential, propensity score-matched, new-user comparative effectiveness study using target trial emulation framework included adults with T2D receiving metformin monotherapy in a Canadian general population database from January 1, 2014, to June 30, 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240011-7\"><jats:title>Exposures<\/jats:title><jats:p>Initiation of SGLT2i vs sulfonylurea.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240011-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was incident gout diagnosis, ascertained by emergency department (ED), hospital, outpatient, and medication dispensing records. Secondary outcomes were gout-primary hospitalizations and ED visits and major adverse cardiovascular events (MACE), as well as recurrent flare rates among prevalent gout patients. Heart failure (HF) hospitalization was assessed as positive control outcome and osteoarthritis encounters as negative control. For target trial emulations, we used Cox proportional hazards and Poisson regressions with 1:1 propensity score matching (primary analysis) and overlap weighting (sensitivity analysis). The analysis was conducted from September to December, 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240011-9\"><jats:title>Results<\/jats:title><jats:p>Among 34\u202f604 propensity score matched adults with T2D initiating SGLT2i or sulfonylurea (20\u202f816 [60%] male, mean [SD] age, 60 [12.4] years), incidence of gout was lower among SGLT2i initiators (4.27 events per 1000 person-years) than sulfonylurea initiators (6.91 events per 1000 person-years), with a hazard ratio (HR) of 0.62 (95% CI, 0.48-0.80) and a rate difference (RD) of \u22122.64 (95% CI, \u22123.99 to \u22121.29) per 1000 person-years. Associations persisted regardless of sex, age, or baseline diuretic use. SGLT2i use was also associated with fewer recurrent flares among gout patients (rate ratio, 0.67; 95% CI, 0.55-0.82; and RD, \u221220.9; 95% CI, \u221231.9 to \u221210.0 per 1000 person-years). HR and RD for MACE associated with SGLT2i use were 0.87 (95% CI, 0.77-0.98) and \u22123.58 (95% CI, \u22126.19 to \u22120.96) per 1000 person-years. For control outcomes, SGLT2i users had lower risk of HF (HR, 0.53; 95% CI, 0.38-0.76), as expected, with no difference in osteoarthritis (HR, 1.11; 95% CI, 0.94-1.34). Results were similar when applying propensity score overlap weighting.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240011-10\"><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.0376","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T15:32:10Z","timestamp":1713195130000},"page":"650","source":"Crossref","is-referenced-by-count":21,"title":["Sodium-Glucose Cotransporter-2 Inhibitors vs Sulfonylureas for Gout Prevention Among Patients With Type 2 Diabetes Receiving Metformin"],"prefix":"10.1001","volume":"184","author":[{"given":"Natalie","family":"McCormick","sequence":"first","affiliation":[{"name":"Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston"},{"name":"The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"Arthritis Research Canada, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chio","family":"Yokose","sequence":"additional","affiliation":[{"name":"Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston"},{"name":"The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Lu","sequence":"additional","affiliation":[{"name":"Arthritis Research Canada, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah J.","family":"Wexler","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"Diabetes Center, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Antonio","family":"Avi\u00f1a-Zubieta","sequence":"additional","affiliation":[{"name":"Arthritis Research Canada, Vancouver, British Columbia, Canada"},{"name":"Division of Rheumatology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary A.","family":"De Vera","sequence":"additional","affiliation":[{"name":"Arthritis Research Canada, Vancouver, British Columbia, Canada"},{"name":"Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rozalina G.","family":"McCoy","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore"},{"name":"University of Maryland Institute for Health Computing, Bethesda"},{"name":"Division of Gerontology, Department of 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