Effectiveness of SGLT2 Inhibitors vs DPP-4 Inhibitors on Liver Function in Patients with Type 2 Diabetes

Diabetes, Obesity & Metabolism Journal: Published: December 2023

Type 2 diabetes (T2D) and liver diseases are closely associated. T2D is an independent risk factor for chronic liver diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD), non-alcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma, and MASLD is an independent risk factor for T2D.

Liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT), are markers for liver function.

In particular, elevated ALT levels are independently associated with an increased risk of cardiovascular and diabetes-related mortality.

TAKE-HOME MESSAGE

This retrospective study compared the effects of two types of medication — SGLT2 inhibitors (SGLT2is) and DPP-4 inhibitors (DPP-4is) — on liver function in patients with type 2 diabetes.

The study included 1078 patients treated with SGLT2is (canagliflozin, dapagliflozin, empagliflozin) and 7499 with DPP-4is (sitagliptin, saxagliptin, linagliptin, and vildagliptin).

Both treatments were associated with a reduction in alanine aminotransferase levels, but the SGLT2i group had a greater reduction in alanine aminotransferase levels and the levels of other liver function markers.

SGLT2 is could be a treatment option for patients with type 2 diabetes who require additional benefits to improve liver functions.

Available in Google Play Store

Conclusions

In this study, improvements in various measures, including ALT, the FIB-4 index, GGT and albumin, were observed with SGLT2is compared with DPP4is, suggesting that SGLT2is may provide hepatoprotective benefits, including the prevention of liver fibrosis, in patients with T2D in Japan.

Doctors Liked to Read More

Abstract

Aim: To compare the effects of sodium-glucose co-transporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) on liver function in patients with type 2 diabetes (T2D) in Japan.

Materials and methods: This was a Japanese retrospective cohort study using the RWD Database (1 January 2015 to 24 September 2021). Patients newly treated with an SGLT2i or a DPP4i were matched 1:4 (SGLT2i:DPP4i) using propensity score. The primary endpoint was the change from baseline to 1 year after the index date in alanine aminotransferase (ALT). Secondary endpoints included change from baseline in various laboratory test results, including the Fibrosis-4 (FIB-4) index, aspartate aminotransferase, gamma-glutamyl transpeptidase (GGT), albumin and HbA1c. Endpoints were compared between treatment groups using Welch's t-test in the full population and in subgroups stratified by baseline characteristics.

Results: Baseline characteristics of 955 and 3063 matched patients newly treated with an SGLT2i and a DPP4i, respectively, were well balanced. Patients receiving an SGLT2i had significantly greater reductions in ALT, FIB-4 index and GGT and a significantly greater increase in albumin than patients receiving a DPP4i. A significantly greater change from baseline in ALT was observed in the SGLT2i group than in the DPP4i group among subgroups with lower baseline FIB-4 index and HbA1c.

Conclusions: In this study, improvements in various measures, including ALT, the FIB-4 index, GGT and albumin, were observed with SGLT2is compared with DPP4is, suggesting that SGLT2is may provide hepatoprotective benefits, including the prevention of liver fibrosis, in patients with T2D in Japan.

Rate This Article