People with diabetes have an increased risk of developing kidney stones, often termed nephrolithiasis. A recent research published in ‘Diabetes Care’ compared the risk of nephrolithiasis among type 2 diabetes patients who initiated sodium–glucose cotransporter 2 inhibitors (SGLT2is) versus dipeptidyl peptidase 4 inhibitors (DPP4is), individually within stone never- and ever-formers.

      A population-based cohort study was conducted using the Korea National Health Insurance Service database, comparing initiators of SGLT2is versus DPP4is. The primary outcome was incident nephrolithiasis. Subgroup analyses by sex, age, thiazide co-use, and baseline cardiovascular risk were also done. The 17,006 PS-matched pairs of SGLT2i and DPP4i initiators were pooled from stone never-formers (105,378 pairs) and ever-formers (11,628 pairs).

      The Target Trial Emulation study observed that over a mean of 654 days, the risk of nephrolithiasis was lower in SGLT2i initiators than in DPP4i initiators. The latter had a higher absolute risk reduction even though the former had a higher relative risk reduction. Near-null associations were found for osteoarthritis encounters. Results were consistent across subgroups.