Hyon Choi of Harvard Medical School and colleagues from Canada and the United States conducted an emulation of randomized trials and concluded that antidiabetic agents from the SGLT1 inhibitor group (gliflozins) are superior to GLP-1 agonists and DPP-4 inhibitors (gliptins) in preventing kidney stone formation in patients with a history of nephrolithiasis, including those with concomitant gout. The analysis included 20,146 patients with type 2 diabetes and nephrolithiasis, with or without gout, from Canadian population-based databases from January 2014 to June 2022. The researchers were interested in the incidence of recurrent nephrolithiasis while taking these medications. The results were published in the journal BMJ.
The incidence of clinically registered recurrent nephrolithiasis was found to be 105.3 per 1,000 patient-years with gliflozins versus 156.4 per 1,000 patient-years with GLP-1 agonists; the incidence rate ratio (IRR) adjusted for confounding factors was 0.67 (95% confidence interval 0.57–0.79). When gliptins were used as alternative comparators, gliflozins also showed an advantage: IRR 0.73 (95% confidence interval 0.68–0.78). Similar ratios were observed for concomitant gout, with gliflozins being associated with a lower rate of exacerbations of this disease compared with other antidiabetic drugs. The use of drugs in this group also correlated positively with the incidence of genital infections, but not osteoarthritis or appendicitis.
