Effect of the glomerular filtration rate on uric acid metabolism in a retrospective cohort of type-2 diabetes mellitus patients on sglt-2 inhibitor therapy.

Sodium glucose cotransporter-2 (SGLT-2) inhibitors are oral antidiabetic agents used in the treatment of type-2 diabetes mellitus (type-2 DM). SGLT-2 inhibitors are known to provide effective glycemic control through urinary glucose excretion, as well as to reduce serum uric acid (UA) levels, which affect the prognosis of diabetes. The aim of the study was to investigate the effect of different glomerular filtration rates (GFR) on serum UA level changes in Type-2 DM patients receiving SGLT-2 inhibitor therapy. Between January 1, 2017 and September 30, 2022, 3004 patients who were admitted to the Endocrine and Metabolic Diseases Outpatient Clinic of Başkent University Ankara Hospital, diagnosed with Type-2 DM and prescribed SGLT-2 inhibitor treatment reports and prescriptions constituted the study population. Exclusion criteria were that the patient was not taking SGLT2 inhibitors continuously, did not attend the 3rd month and/or 12th month follow-up visits, was taking medications that affect serum UA levels, and was being treated for gout. Serum HbA1C, fasting blood glucose (FBG), creatinine, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride, UA and urine glucose levels measured before receiving SGLT-2 inhibitor medication report were compared with the values measured at 3 months and 12 months under SGLT-2 inhibitor treatment in 410 patients who constituted the sample of the study through the Hospital Medical Information System. Patients were divided into 3 groups (GFR ≥90, 60-89, 30-59 ml/min/1.73m2) according to the Kidney Disease Foundation for Improving Global Outcomes (KDIGO) and the effect of SGLT-2 inhibitors on uric acid levels according to GFR was analyzed. The study group consisted of 227 male and 183 female patients. The mean age of the patients was 59.1±11.55/year. Serum HbA1C, FBG, creatinine, LDL, triglycerides, and UA levels decreased, whereas HDL and urine glucose levels increased under drug treatment compared to before SGLT-2 inhibitor treatment. In patients with GFR between 30-59 ml/min/1.73m2, no significant difference was found between serum UA values at pre-drug (6.35±1.31), 3rd month under drug therapy (6.02±1.05) and 12th month under drug therapy (5.97±1.21)(p=0.368). The study found that the effect of SGLT-2 inhibitors on serum UA levels differed according to GFR. The study showed that SGLT-2 inhibitors are not only antidiabetic drugs, but may also have a protective role against hyperlipidemia and hyperuricemia-related diseases with their effects on lipid profile and serum uric acid levels in patients with preserved GFR.