Scheen André J
Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), Liège University, Liège, Belgium.
Division of Diabetes, Nutrition and Metabolic Disorders, CHU Liège, Liège, Belgium.
Expert Opin Drug Metab Toxicol. 2023 Jul-Dec;19(8):543-553. doi: 10.1080/17425255.2023.2252333. Epub 2023 Aug 29.
Type 2 diabetes and liver disease, mainly metabolic-associated fatty liver disease (MAFLD) and more rarely cirrhosis, coexist in many patients. This duality has direct implications for the physician when choosing glucose-lowering agents, with classical concerns but also recent new hopes.
This updated comprehensive review will consider the pharmacokinetics, the tolerance/safety profile, the benefit/risk balance in cirrhosis, the effects on MAFLD and the risk of hepatocellular carcinoma of old and new glucose-lowering compounds in patients with liver disease, with a special focus on glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors.
We are currently facing a new paradigm in the management of patients with diabetes and liver disease. From previous reluctance when using antidiabetic agents (except insulin) in diabetic patients with hepatic impairment because of safety concerns, the commercialization of novel glucose-lowering agents has changed the scene. These agents, which have a good safety profile, are associated with weight loss and pleiotropic effects. They have proven their efficacy in improving MAFLD. However, more specific studies are still needed to prove their efficacy in preventing the progression to fibrosis/cirrhosis and confirm this new opportunity for the management of patients with diabetes and liver disease.
2型糖尿病与肝脏疾病，主要是代谢相关脂肪性肝病（MAFLD），较少见的是肝硬化，在许多患者中共存。这种双重性在医生选择降糖药物时具有直接影响，既有传统的担忧，也有近期新的希望。
本次更新的全面综述将考虑肝病患者中新型和传统降糖化合物的药代动力学、耐受性/安全性概况、在肝硬化中的获益/风险平衡、对MAFLD的影响以及肝细胞癌风险，特别关注胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白2抑制剂。
我们目前正面临糖尿病和肝病患者管理的新范式。由于安全担忧，以往在肝功能损害的糖尿病患者中使用抗糖尿病药物（胰岛素除外）时有所顾虑，而新型降糖药物的商业化改变了这一局面。这些药物具有良好的安全性，与体重减轻和多效性作用相关。它们已证明在改善MAFLD方面的疗效。然而，仍需要更具体的研究来证明其在预防进展为纤维化/肝硬化方面的疗效，并确认这一糖尿病和肝病患者管理的新机遇。
