Hyon Choi from Harvard Medical School and colleagues from Canada and the United States conducted an emulation of randomized trials and concluded that antidiabetic drugs from the group of SGLT1 inhibitors (gliflozins) are better than GLP-1 agonists and DPP-4 inhibitors (gliptins) in preventing kidney stone formation in patients with previous nephrolithiasis, including concomitant gout. The analysis included 20,146 patients with type 2 diabetes and nephrolithiasis with or without gout from Canadian population databases from January 2014 to June 2022. The researchers were interested in the incidence of recurrent nephrolithiasis when taking the listed drugs. The results are published in the BMJ journal.
The incidence of clinically registered recurrent nephrolithiasis was found to be 105.3 per 1000 patient-years with gliflozins versus 156.4 per 1000 patient-years with GLP-1 agonists; the incidence rate ratio (IRR) adjusted for confounding factors was 0.67 (95% CI 0.57–0.79). When gliptins were used as alternative comparators, gliflozins also showed an advantage: IRR 0.73 (95% CI 0.68–0.78). Similar ratios were observed for concomitant gout, with gliflozins associated with a lower rate of exacerbations of this disease compared with other antidiabetic drugs. The use of drugs in this group also positively correlated with the incidence of genital infections, but not osteoarthritis or appendicitis.
