The BMJ research: sodium-glucose cotransporter-2 inhibitors and risk of autoimmune rheumatic diseases
In October 2025, The BMJ published the first nationwide population based cohort study to examine the association between sodium-glucose cotransporter-2 (SGLT2) inhibitors and risk of autoimmune rheumatic diseases (ARDs). Drawing on data from more than 2 million adults in South Korea, the study compared SGLT2 inhibitors with sulfonylureas and identified a modest but statistically significant reduction in overall ARD risk among SGLT2 inhibitor users.
Since publication, the sodium-glucose cotransporter-2 inhibitors and risk of autoimmune rheumatic diseases: population based cohort study has attracted international media coverage. Early citation tracking and Mendeley readership indicate emerging scholarly engagement.
Subsequent analyses from other settings have explored the association using different comparator groups. A population based cohort study conducted in the Canadian province of British Columbia compared SGLT2 inhibitors with dipeptidyl peptidase-4 (DPP4) inhibitors rather than sulfonylureas. In that analysis, there was no overall reduction in risk of ARDs among SGLT2 inhibitor users. However, a lower risk of certain systemic autoimmune rheumatic diseases was observed in subgroup analyses.
An abstract presented at ACR Convergence 2025 also examined SGLT2 inhibitors in comparison with DPP4 inhibitors. While some findings were consistent with the South Korean study, the overall results were not identical, reflecting differences in comparator groups and study populations.
Taken together, the evidence suggests that the observed association between SGLT2 inhibitors and autoimmune rheumatic disease risk may vary depending on comparator therapy and population. The South Korean nationwide analysis provides large scale evidence using sulfonylureas as the primary comparator, whereas the Canadian provincial cohort used DPP4 inhibitors as the active comparator. These differences are important for interpretation and indicate that results can differ by drug class and setting at a population level.
As noted in the linked The BMJ editorial authored by rheumatologist Derin Karacabeyli, the South Korean nationwide study provides an important foundation for future research. The editorial emphasises that replication across different populations, settings, and comparator groups is required to confirm and extend observations on potential prevention of autoimmune rheumatic diseases. While the findings alone are unlikely to change clinical practice, they represent the first full length publication to suggest a reduction in autoimmune rheumatic disease risk associated with SGLT-2 inhibitors.
Impact at a glance
First nationwide analysis of SGLT2 inhibitors and overall autoimmune rheumatic disease risk
Two million adults in South Korea studied
Sits within the top 5% of all research outputs scored by Altmetric
Generated international discussion and secondary analyses in other jurisdictions
Contributed to an emerging research agenda on immune modulation
"Because randomised trials would not be feasible in this setting, high quality observational studies like the one published in The BMJ are an important contribution to the literature."
Derin Karacabeyli
Rheumatologist, Vancouver General Hospital, University of British Columbia, Canada
