Krishnan Arunkumar, Schneider Carolin V, Mukherjee Diptasree, Woreta Tinsay A, Alqahtani Saleh A
Department of Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, North Carolina, USA.
J Diabetes. 2025 Apr;17(4):e70069. doi: 10.1111/1753-0407.70069.
The management of metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) presents a significant clinical challenge, with a focus on preventing progression to liver and renal complications.
To evaluate the liver and renal outcomes among new users of sodium-glucose cotransporter 2 inhibitors (SGLT2i) versus glucagon-like peptide-1 receptor agonists (GLP-1RA), dipeptidyl peptidase-4 inhibitors (DPP4i) and other anti-diabetic medications in patients with MASLD and T2DM.
Retrospective cohort study.
Electronic health records.
A total number of 88 306 patients with MASLD and T2DM were included in a propensity score-matched analysis comparing the effects of anti-diabetic drugs.
Patients were categorized into groups based on their initiation of anti-diabetic medications.
The primary outcomes were the incidence of cirrhosis, hepatic decompensations, and hepatocellular carcinoma. Secondary outcomes were a progression of chronic kidney disease (CKD), severity of CKD stages, and the need for hemodialysis.
In the SGLT2i versus DPP4i, a reduced risk of cirrhosis was observed in the SGLT2i (HR: 0.97), along with fewer hepatic decompensations (HR: 0.84) and a lower incidence of HCC (HR: 0.50). CKD progression, particularly to stages 4-5, was significantly lower in the SGLT2i (HR: 0.53), as was hemodialysis (HR: 0.38). However, SGLT2i exhibited a slightly lower risk of CKD progression (HR: 0.77) and a reduced need for hemodialysis (HR: 0.71) compared to the GLP-1RA, while there was no difference in hepatic outcomes between the GLP-1RA and SGLT2i.
SGLT2 inhibitors in patients with MASLD and T2DM demonstrated reduced risks of liver complications and a favorable impact on renal outcomes. These findings support the preferential consideration of SGLT2i in managing this patient population, particularly for mitigating the progression of liver and kidney diseases.
代谢功能障碍相关脂肪性肝病（MASLD）和2型糖尿病（T2DM）的管理面临重大临床挑战，重点在于预防进展为肝脏和肾脏并发症。
评估钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）新使用者与胰高血糖素样肽-1受体激动剂（GLP-1RA）、二肽基肽酶-4抑制剂（DPP4i）及其他抗糖尿病药物在MASLD和T2DM患者中的肝脏和肾脏结局。
回顾性队列研究。
电子健康记录。
共88306例MASLD和T2DM患者纳入倾向评分匹配分析，比较抗糖尿病药物的效果。
根据患者开始使用抗糖尿病药物的情况进行分组。
主要结局为肝硬化、肝失代偿和肝细胞癌的发生率。次要结局为慢性肾脏病（CKD）进展、CKD分期严重程度及血液透析需求。
在SGLT2i与DPP4i的比较中，SGLT2i组肝硬化风险降低（HR：0.97），肝失代偿较少（HR：0.84），HCC发生率较低（HR：0.50）。SGLT2i组CKD进展，尤其是进展至4 - 5期的情况显著更低（HR：0.53），血液透析需求也更低（HR：0.38）。然而，与GLP-1RA相比，SGLT2i的CKD进展风险略低（HR：0.77），血液透析需求减少（HR：0.71），而GLP-1RA与SGLT2i在肝脏结局方面无差异。
MASLD和T2DM患者使用SGLT2抑制剂可降低肝脏并发症风险，并对肾脏结局产生有利影响。这些发现支持在管理该患者群体时优先考虑SGLT2i，特别是用于减轻肝脏和肾脏疾病的进展。
