Wang Gang, Wang Guixia
From the Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China.
Saudi Med J. 2025 Mar;46(3):213-225. doi: 10.15537/smj.2025.46.3.20240920.
Hyperuricemia and type 2 diabetes mellitus (T2DM) are interconnected, in that each disorder increases risk for the other. Some antidiabetic drugs may decrease the level of serum uric acid (SUA). This narrative review describes the effects of multiple antidiabetic drugs on the SUA level and their possible mechanisms of action in patients with T2DM. The results showed that sodium glucose contransporter-2 inhibitors (SGLT2is), thiazolidinediones, metformin, and linagliptin decreased the SUA; insulin, sitagliptin, and alogliptin increased the SUA; and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sulfonylureas, and alpha-glucosidase inhibitors had little effect on the SUA. Sodium glucose contransporter-2 inhibitors appeared to have the greatest effect on lowering SUA, possibly because they reduce pentose phosphate pathway metabolism and increase the renal excretion of urate by altering renal tubular uric acid transporters. Among all antidiabetic drugs currently used, SGTL2is appeared to be the most promising therapeutic option for T2DM patients with hyperuricemia.
高尿酸血症与2型糖尿病（T2DM）相互关联，因为每种疾病都会增加另一种疾病的发病风险。一些抗糖尿病药物可能会降低血清尿酸（SUA）水平。这篇叙述性综述描述了多种抗糖尿病药物对T2DM患者SUA水平的影响及其可能的作用机制。结果显示，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）、噻唑烷二酮类、二甲双胍和利格列汀可降低SUA；胰岛素、西他列汀和阿格列汀会升高SUA；胰高血糖素样肽-1受体激动剂（GLP-1 RA）、磺脲类和α-葡萄糖苷酶抑制剂对SUA影响不大。钠-葡萄糖协同转运蛋白2抑制剂似乎对降低SUA的作用最大，可能是因为它们减少磷酸戊糖途径代谢，并通过改变肾小管尿酸转运体增加尿酸的肾脏排泄。在目前使用的所有抗糖尿病药物中，SGTL2i似乎是T2DM合并高尿酸血症患者最有前景的治疗选择。
