Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia.
Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, 3004, Australia; Faculty of Medicine, Monash University, Melbourne, 3800, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia.
Ann Hepatol. 2023 Nov-Dec;28(6):101142. doi: 10.1016/j.aohep.2023.101142. Epub 2023 Jul 18.
Among people with type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD) is very common and has an increased risk of clinically significant liver disease. The use of sodium-glucose co-transporter 2 (SGLT2i) inhibitors and glucagon-like peptide-1 (GLP-1a) receptor agonists is endorsed to reduce major cardiovascular events and/or progression of chronic kidney disease. Their prevalence of use in people with T2D and co-existent NAFLD remains unclear. We sought to determine the prevalence of use of these medications at two different time periods, and their association with prevalence of clinically significant liver disease.
Consecutive people with type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD) were recruited from diabetes clinics between Jun-2021 and Jun-2022 ('current' cohort). Liver stiffness measurements (LSM) using FibroScan were performed. Medication data were collected prospectively at recruitment and verified with the dispensing pharmacy or general practitioner medical records. Data for a historical cohort with NAFLD and T2D recruited from the same clinics during 2015-2017 ('historical' cohort) were available. Logistic regression was used to evaluate factors associated with LSM <8.0 or ≥8 kPa (clinically significant fibrosis).
There were 292 participants, 177 in the historical cohort and 115 in the current cohort. In the current cohort, 57.4% of patients with T2D and NAFLD were taking a GLP-1a and 42.6% were taking a SGLT2i; a 2.6 to 3.4-fold higher prevalence than in 2015-2017. A lower proportion of the current cohort (23.9% compared to 38.4%) had clinically significant fibrosis (LSM ≥8 kPa; p = 0.012). When the cohorts were pooled and differences adjusted for in multivariable logistic regression analysis, patients taking a GLP-1a or a SGLT2i were 2 times more likely to have a lower LSM (<8 kPa) compared to patients not taking these drugs (OR=2.05, 95%CI 1.07-3.94, p = 0.03 and OR 2.07 95%CI 1.04-4.11, p = 0.04, respectively).
The observation of a lower LSM in people taking SGLT2i and/or GLP-1a following adjustment for other relevant clinico-demographic variables provides support for clinical trials to assess their efficacy in reducing the progression of NAFLD.
在 2 型糖尿病（T2D）患者中，非酒精性脂肪性肝病（NAFLD）非常常见，并且存在临床显著肝脏疾病的风险增加。钠-葡萄糖共转运蛋白 2（SGLT2i）抑制剂和胰高血糖素样肽-1（GLP-1a）受体激动剂的使用被推荐用于降低主要心血管事件和/或慢性肾脏病的进展。它们在同时患有 T2D 和 NAFLD 的人群中的使用情况仍不清楚。我们旨在确定这两种药物在两个不同时间段的使用情况，并确定其与临床显著肝脏疾病的患病率之间的关联。
连续招募了 2021 年 6 月至 2022 年 6 月期间在糖尿病诊所就诊的 2 型糖尿病（T2D）和非酒精性脂肪性肝病（NAFLD）患者（“当前”队列）。使用 FibroScan 进行肝硬度测量（LSM）。在招募时前瞻性收集药物数据，并通过配药药房或全科医生的病历进行验证。在 2015 年至 2017 年期间，从同一诊所招募了具有 NAFLD 和 T2D 的历史队列的患者，且有数据可用。使用逻辑回归评估与 LSM <8.0 或≥8kPa（临床显著纤维化）相关的因素。
共有 292 名参与者，其中 177 名来自历史队列，115 名来自当前队列。在当前队列中，57.4%的 T2D 和 NAFLD 患者服用 GLP-1a，42.6%的患者服用 SGLT2i；这一比例比 2015-2017 年高 2.6 至 3.4 倍。与 2015-2017 年相比，当前队列中（23.9%比 38.4%）具有临床显著纤维化（LSM≥8kPa）的比例较低（p=0.012）。当将两个队列合并并在多变量逻辑回归分析中调整差异时，与未服用这些药物的患者相比，服用 GLP-1a 或 SGLT2i 的患者 LSM（<8kPa）降低的可能性要高出 2 倍（OR=2.05，95%CI 1.07-3.94，p=0.03 和 OR 2.07 95%CI 1.04-4.11，p=0.04，分别）。
在调整其他相关临床人口统计学变量后，观察到 SGLT2i 和/或 GLP-1a 治疗的患者 LSM 较低，这为临床试验评估其在降低 NAFLD 进展方面的疗效提供了支持。
