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Sodium Glucose Cotransporter 2 Inhibitor Use in Diabetic Patients With Cirrhosis Improves Liver-Related Outcomes and
Sajid Jalil1, Khurram Bari2, Khalid Mumtaz3
1Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, USA.
Introduction:
The liver outcomes of sodium glucose cotransporter 2 inhibitor (SGLT-2i) in type 2 diabetes mellitus (T2DM) patients with cirrhosis have not been well studied.
Methods:
We conducted a retrospective cohort study (January 1, 2010-December 31, 2025) using 2 databases. Adults aged 18 years or older with T2DM and cirrhosis newly treated with SGLT-2i were identified. Patients were grouped into those receiving SGLT-2i and those not receiving SGLT-2i. Baseline characteristics were compared before and after propensity score matching. The primary outcome was the incidence of hepatic decompensation among SGLT-2i users versus nonusers.
Results:
The intervention group consisted of 14,231 SGLT-2i users, and the control group consisted of 249,746 non-SGLT-2i users. After 1:1 propensity score matching, use of SGLT-2i was associated with reduced composite outcome of hepatic decompensation compared with control group at 1 year (9.9% vs 12.5%, P = 0.001), at 3 years (16.4% vs 18.1%, P < 0.001), and 5 years (19.9% vs 21.9%, P < 0.001). Hepatocellular carcinoma (HCC) rates were significantly lower in the SGLT-2i users at 1 year (2.3% vs 3.5%, P = 0.001), at 3 years (2.9% vs 4.2%, P = 0.001), and at 5 years (3.4% vs 4.8%, P = 0.001). There was a 31% reduction in mortality in the SGL-T2i arm (hazard ratio: 0.69; confidence interval: 0.56-0.83, P < 0.001), as compared with the non-SGLT-2i arm. These findings were validated in the EVERSANA database.
Conclusions:
Use of SGLT-2i was associated with a reduced composite outcome of hepatic decompensation and mortality among patients with T2DM and cirrhosis compared with non-SGLT-2i users across 2 independent data sets. Prospective randomized controlled trials are needed to confirm these findings.
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