Impact of oral semaglutide on serum urate levels in people with type 2 diabetes: A retrospective real-world analysis (URISEMA study).

BACKGROUND: Evidence on the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on serum urate (SU) levels in people with type 2 diabetes (PWT2D) is limited. This study investigates the effect of oral semaglutide on SU levels. METHODS: Retrospective, observational study including PWT2D who were prescribed oral semaglutide. The primary endpoint was achieving SU levels below 6 mg/dL at 12 months of follow-up (FU). Secondly, we assessed baseline factors associated with achieving SU levels of <6 mg/dL and average reductions in SU levels. RESULTS: The study included 236 patients (median age 64 years, BMI 33.8 kg/m², HbA1c 7.6 %, 40.7 % women, 52.3 % on SGLT2 inhibitors). Baseline SU was 5.2 mg/dL, 66.1 % had SU levels <6 mg/dL, and 23.7 % had hyperuricemia. Under oral semaglutide, 70.7 % and 76 % showed SU <6 mg/dL at 6 and 12 months, respectively. After multivariate adjustment, only SU ≥7 mg/dL (OR 4.54, 95 %CI 1.08-19.25) and switching from a DPP-4 inhibitor (OR 6.53, 95 %CI 1.57-27.32) were associated with achieving the SU target. SU decreased by 0.1 mg/dL after 6 months (p = 0.52) and by 0.2 mg/dL (p = 0.01) at 12 months FU. Greater reductions were observed in those with baseline SU >6 mg/dL (0.6 mg/dL and 0.8 mg/dl, respectively; all p < 0.001). Changes in SU levels were independent of improved metabolic control, weight loss, or baseline use of GLP-1 RAs or SGLT2 inhibitors. CONCLUSION: Oral semaglutide in real-world settings showed a modest reduction in SU levels in PWT2D, particularly linked to baseline hyperuricemia (with notable reduction figures) and switching from DPP-4 inhibitors.