Oral semaglutide reduced serum urate levels by 0.6-0.8 mg/dL in type 2 diabetes patients with elevated baseline levels, achieving target levels below 6 mg/dL in a significant proportion — independent of weight loss or metabolic improvements.
0.6-0.8 mg/dL urate reduction (p<0.001)Oral semaglutide lowered serum urate independently of weight loss and metabolic improvements in T2DM patients with elevated baseline levels
What the researchers found
Among 236 patients (median age 64, BMI 33.8, baseline SU 5.2 mg/dL), oral semaglutide achieved the primary endpoint of SU < 6 mg/dL in a significant proportion at 12 months. Patients with baseline SU ≥ 6 mg/dL showed reductions of 0.6 and 0.8 mg/dL respectively (all p < 0.001). Changes were independent of metabolic control improvement, weight loss, or baseline use of GLP-1RAs or SGLT2 inhibitors. Switching from DPP-4 inhibitors was associated with particularly notable SU reductions.
Why it matters
Hyperuricemia and gout are common in type 2 diabetes and significantly affect quality of life. Finding that semaglutide lowers uric acid independently of its metabolic effects adds yet another potential benefit to this GLP-1 drug's growing therapeutic profile. For patients with diabetes and elevated uric acid — a combination that increases cardiovascular and kidney risk — semaglutide may address multiple problems simultaneously.
How the study worked
Retrospective real-world observational study (URISEMA) of 236 patients with type 2 diabetes prescribed oral semaglutide. Primary endpoint was achieving SU < 6 mg/dL at 12 months. Secondary endpoints included baseline factors associated with achieving target SU and average SU reductions. Multivariate analysis assessed independence from metabolic improvements.
What this study cannot tell us
Retrospective observational design without a control group. The sample size (n=236) is modest. The abstract appears to have data presentation issues (incomplete sentences), suggesting some numerical findings may be unclear. Without randomization, residual confounding cannot be excluded despite multivariate analysis. Only oral semaglutide was studied — injectable formulations may differ. The mechanism of uric acid reduction was not investigated.
How to read the evidence
This is a real-world retrospective observational study without a control group. While the sample size is adequate for detecting the observed effect and independence from confounders was assessed, the lack of randomization and blinding limits causal conclusions.
When this study was published
Published in 2025, this study addresses the emerging understanding of GLP-1RA effects on uric acid metabolism — an area with limited prior evidence that is becoming increasingly relevant as these drugs are widely prescribed.
The bigger picture
GLP-1 receptor agonists continue to reveal benefits beyond glucose and weight management. The uric acid-lowering effect is particularly interesting because hyperuricemia is independently associated with cardiovascular disease, kidney disease, and gout — conditions that frequently co-occur with diabetes and obesity. If confirmed in larger studies, this adds to the compelling multi-benefit profile of GLP-1 drugs that already includes cardiovascular protection, kidney protection, and liver fat reduction.
Questions still open
- Does semaglutide's urate-lowering effect reduce gout flares in diabetic patients with hyperuricemia?
- Is the urate-lowering effect a class effect of all GLP-1RAs or specific to semaglutide?
- What is the mechanism by which semaglutide lowers uric acid independent of weight loss and metabolic improvement?
Common questions
Why does uric acid matter for people with diabetes?
Does this mean semaglutide can treat gout?
Read the original research
Impact of oral semaglutide on serum urate levels in people with type 2 diabetes: A retrospective real-world analysis (URISEMA study).
Seminars in arthritis and rheumatism, 74, 152807
Citation
Moreno-Pérez, Oscar; Tejera-Muñoz, Antonio; Carreño-Valdivia, Rubén; Rodríguez-Bedoya, María; Guillén-Morote, Cristina; Roldán-Sánchez, Ada; Andrés, Mariano. (2025). Impact of oral semaglutide on serum urate levels in people with type 2 diabetes: A retrospective real-world analysis (URISEMA study).. Seminars in arthritis and rheumatism, 74, 152807. https://doi.org/10.1016/j.semarthrit.2025.152807