SIRT1 and gout: First, SGLT2i could reduce serum urate concentration by increasing kidney urate elimination.39 This effect is attributed to the glucose in the urine competing with soluble urate for glucose transporter 9–mediated reabsorption in the proximal tubule due to the reduced transport function of SGLT2.40 Additionally, SGLT2i enhance sirtuin-1, an enzyme that inhibits xanthine oxidase and decreases serum urate levels.41 Second, SGLT2i may suppress pyrin domain–containing 3 inflammasome activation and attenuate interleukin 1β secretion42 and thus may lower the risk of gout flares.