1st Propaedeutic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece.
Liver Int. 2024 Apr;44(4):884-893. doi: 10.1111/liv.15851. Epub 2024 Jan 31.
Type 2 diabetes mellitus (T2DM) and liver cirrhosis are clinical entities that frequently coexist, but glucose-lowering medication options are limited in cirrhotic patients. Sodium-glucose linked transporter 2 (SGLT2) inhibitors are a class of glucose-lowering medication that act independently of insulin, by causing glycosuria in the proximal convoluted tubule. In this review, we aimed to briefly present the main data and to provide insight into the pathophysiology and potential usefulness of SGLT2 inhibitors in cirrhotic patients with or without T2DM. SGLT2 inhibitors have been proven useful as antidiabetic treatment in patients with metabolic liver disease, with most robust data from patients with metabolic dysfunction-associated steatotic liver disease (MASLD), where they also showed improvement in liver function parameters. Moreover, it has been suggested that SGLT2 inhibitors may have effects beyond their antidiabetic action. Accordingly, they have exhibited cardioprotective effects, expanding their indication in patients with heart failure without T2DM. Since decompensated liver cirrhosis and congestive heart failure share common pathophysiological features, namely renin-angiotensin-aldosterone axis and sympathetic nervous system activation as well as vasopressin secretion, SGLT2 inhibitors could also be beneficial in patients with decompensated cirrhosis, even in the absence of T2DM.
2 型糖尿病(T2DM)和肝硬化是经常同时存在的临床实体,但肝硬化患者的降糖药物选择有限。钠-葡萄糖协同转运蛋白 2(SGLT2)抑制剂是一类降糖药物,通过在近端曲管引起糖尿,不依赖胰岛素发挥作用。在这篇综述中,我们旨在简要介绍主要数据,并深入了解 SGLT2 抑制剂在伴有或不伴有 T2DM 的肝硬化患者中的病理生理学和潜在用途。SGLT2 抑制剂已被证明可作为代谢性肝病患者的降糖治疗药物,在代谢功能障碍相关脂肪性肝病(MASLD)患者中具有最有力的数据,它们还显示出肝功能参数的改善。此外,有人认为 SGLT2 抑制剂可能具有超越其降糖作用的效果。因此,它们在没有 T2DM 的心力衰竭患者中表现出心脏保护作用,扩大了其适应症。由于失代偿性肝硬化和充血性心力衰竭具有共同的病理生理特征,即肾素-血管紧张素-醛固酮轴和交感神经系统激活以及血管加压素分泌,因此即使在没有 T2DM 的情况下,SGLT2 抑制剂也可能对失代偿性肝硬化患者有益。