Sodium-Glucose Cotransporter 2 Inhibitors Use in Patients With Liver Cirrhosis

Abstract

Aims

Cirrhosis and diabetes mellitus can develop and influence each other. We conducted this study to compare the hepatic outcomes of sodium-glucose cotransporter 2 (SGLT2) inhibitor use versus no-use in patients with liver cirrhosis and type 2 diabetes.

Materials and Methods

We identified patients diagnosed with type 2 diabetes and liver cirrhosis from the Taiwan's National Health Insurance Research Database between 1 January 2000 and 31 December 2021. Multivariable-adjusted Cox proportional hazard models were used to compare the risks of decompensated cirrhosis, liver failure, cardiovascular events and mortality between SGLT2 inhibitor users and nonusers.

Results

The mean follow-up period for SGLT2 inhibitor users and nonusers was 2.86 and 2.66 years, respectively. The incidence rates of mortality during follow-up were 29.97 versus 63.18 per 1000 person-years for SGLT2 inhibitor users and nonusers, respectively. The multivariable-adjusted models showed that SGLT2 inhibitor users had lower risks of all-cause mortality (aHR 0.47, 95% CI 0.42–0.52), decompensated cirrhosis (aHR 0.67 95% CI 0.58–0.77), liver failure (aHR 0.58, 95% CI 0.49–0.69), hepatorenal syndrome (aHR 0.54, 95% CI 0.35–0.85) and major adverse cardiovascular events (aHR 0.80, 95% CI 0.52–0.70) than nonusers. A longer cumulative duration of SGLT2 inhibitors had further lower risks of mortality and decompensated cirrhosis.

Conclusions

This nationwide cohort study showed that SGLT2 inhibitor use was associated with a significantly lower risk of mortality, decompensated cirrhosis, liver failure and cardiovascular events in patients with compensated liver cirrhosis and type 2 diabetes. SGLT2 inhibitors may be an option for diabetes management in patients with compensated liver cirrhosis.