Adverse Liver and Renal Outcomes After Initiating SGLT‐2i and GLP‐1RA Therapy Among Patients With Diabetes and MASLD
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Wiley
2025
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| author | Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani |
| author_facet | Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani |
| collection | Wiley Open Access |
| contents | Adverse Liver and Renal Outcomes After Initiating SGLT‐2i and GLP‐1RA Therapy Among Patients With Diabetes and MASLD Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani Journal of Diabetes ABSTRACTContextThe 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.ObjectiveTo 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.DesignRetrospective cohort study.SettingElectronic health records.ParticipantsA 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.InterventionPatients were categorized into groups based on their initiation of anti‐diabetic medications.Main Outcome MeasuresThe 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.ResultsIn 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.ConclusionsSGLT2 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. 10.1111/1753-0407.70069 http://creativecommons.org/licenses/by/4.0/ |
| doi_str_mv | 10.1111/1753-0407.70069 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_1753_0407_70069 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Adverse Liver and Renal Outcomes After Initiating SGLT‐2i and GLP‐1RA Therapy Among Patients With Diabetes and MASLD Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani Journal of Diabetes Adverse Liver and Renal Outcomes After Initiating SGLT‐2i and GLP‐1RA Therapy Among Patients With Diabetes and MASLD Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani Journal of Diabetes ABSTRACTContextThe 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.ObjectiveTo 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.DesignRetrospective cohort study.SettingElectronic health records.ParticipantsA 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.InterventionPatients were categorized into groups based on their initiation of anti‐diabetic medications.Main Outcome MeasuresThe 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.ResultsIn 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.ConclusionsSGLT2 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. 10.1111/1753-0407.70069 http://creativecommons.org/licenses/by/4.0/ |
| title | Adverse Liver and Renal Outcomes After Initiating SGLT‐2i and GLP‐1RA Therapy Among Patients With Diabetes and MASLD |
| topic | Journal of Diabetes |
| url | https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.70069 |