Effects of antidiabetic drugs on the level of serum uric acid in patients who have type 2 diabetes

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.