Adverse Liver and Renal Outcomes After Initiating SGLT-2i and GLP-1RA Therapy Among Patients With Diabetes and MASLD

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2025-04-27 DOI:10.1111/1753-0407.70069

Arunkumar Krishnan, Carolin V. Schneider, Diptasree Mukherjee, Tinsay A. Woreta, Saleh A. Alqahtani

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Abstract

Context

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.

Objective

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.

Design

Retrospective cohort study.

Setting

Electronic health records.

Participants

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.

Intervention

Patients were categorized into groups based on their initiation of anti-diabetic medications.

Main Outcome Measures

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.

Results

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.

Conclusions

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.

Abstract Image

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糖尿病和MASLD患者开始SGLT-2i和GLP-1RA治疗后的不良肝肾结局

代谢功能障碍相关脂肪变性肝病（MASLD）和2型糖尿病（T2DM）的管理是一个重大的临床挑战，重点是防止肝脏和肾脏并发症的进展。目的评价新使用钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）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）及其他降糖药物的MASLD和T2DM患者的肝肾预后。设计回顾性队列研究。设置电子健康记录。共有88306例MASLD和T2DM患者被纳入倾向评分匹配分析，比较抗糖尿病药物的效果。根据患者开始服用抗糖尿病药物的情况，将患者分为不同的组。主要结局指标主要结局指标为肝硬化、肝功能失代偿和肝细胞癌的发生率。次要结局是慢性肾脏疾病（CKD）的进展、CKD分期的严重程度以及是否需要血液透析。结果：与DPP4i相比，SGLT2i组肝硬化风险降低（HR: 0.97），肝失代偿减少（HR: 0.84）， HCC发生率降低（HR: 0.50）。SGLT2i患者的CKD进展，特别是4-5期，显著降低（风险比：0.53），血液透析患者也是如此（风险比：0.38）。然而，与GLP-1RA相比，SGLT2i表现出略低的CKD进展风险（HR: 0.77）和血液透析需求减少（HR: 0.71），而GLP-1RA和SGLT2i之间的肝脏结局没有差异。结论：在MASLD和T2DM患者中使用SGLT2抑制剂可降低肝脏并发症的风险，并对肾脏预后有有利影响。这些发现支持在管理这类患者群体时优先考虑SGLT2i，特别是在缓解肝脏和肾脏疾病进展方面。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.