Impact of <scp>SGLT2</scp> inhibitors in comparison with <scp>DPP4</scp> inhibitors on ascites and death in veterans with cirrhosis on metformin

Saffo, Saad; Kaplan, David E.; Mahmud, Nadim; Serper, Marina; John, Binu; Ross, Joseph S.; Taddei, Tamar H.

doi:10.1111/dom.14488

Cited by 14 publications

(13 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[160] In another observational study, investigators examined by propensity score-matched intention-to-treat analysis in 846 patients on metformin who subsequently received either SGLT2i or DPP-4 inhibitors. [161] Ascites was unchanged, but SGLT2i users had a reduced risk of death (adjusted HR: 0.33; 95% CI: 0.11-0.99; p < 0.05) compared with DPP-4 inhibitor users. Clearly long-term controlled studies are needed to assess the role of SGLT2i in cirrhosis.…”

Section: Pharmacotherapymentioning

confidence: 94%

Diabetes and cirrhosis: Current concepts on diagnosis and management

Castéra

Cusi

2023

Hepatology

View full text Add to dashboard Cite

Type 2 diabetes mellitus is often associated with cirrhosis as comorbidities, acute illness, medications, and other conditions profoundly alter glucose metabolism. Both conditions are closely related in NAFLD, the leading cause of chronic liver disease, and given its rising burden worldwide, management of type 2 diabetes mellitus in cirrhosis will be an increasingly common dilemma. Having diabetes increases cirrhosis-related complications, including HCC as well as overall mortality. In the absence of effective treatments for cirrhosis, patients with type 2 diabetes mellitus should be systematically screened as early as possible for NAFLD-related fibrosis/cirrhosis using noninvasive tools, starting with a FIB-4 index followed by transient elastography, if available. In people with cirrhosis, an early diagnosis of diabetes is critical for an optimal management strategy (ie, nutritional goals, and glycemic targets). Diagnosis of diabetes may be missed if based on A1C in patients with cirrhosis and impaired liver function (Child-Pugh B–C) as anemia may turn the test unreliable. Clinicians must also become aware of their high risk of hypoglycemia, especially in decompensated cirrhosis where insulin is the only therapy. Care should be within multidisciplinary teams (nutritionists, obesity management teams, endocrinologists, hepatologists, and others) and take advantage of novel glucose-monitoring devices. Clinicians should become familiar with the safety and efficacy of diabetes medications for patients with advanced fibrosis and compensated cirrhosis. Management is conditioned by whether the patient has either compensated or decompensated cirrhosis. This review gives an update on the complex relationship between cirrhosis and type 2 diabetes mellitus, with a focus on its diagnosis and treatment, and highlights knowledge gaps and future directions.

show abstract

Section: Pharmacotherapymentioning

confidence: 94%

Diabetes and cirrhosis: Current concepts on diagnosis and management

Castéra

Cusi

2023

Hepatology

View full text Add to dashboard Cite

show abstract

“…However, Zhang et al reported that continuation of metformin after cirrhosis diagnosis reduced the risk of mortality by 57% and no patients developed metformin‐associated lactic acidosis during follow‐up 51 . Although SGLT2 inhibitors are cleared by the liver, Saffo et al reported that SGLT2 inhibitors improved survival for patients with cirrhosis on metformin in comparison with DPP‐4 inhibitors 52 . GLP‐1As is a newer class of anti‐diabetic drugs and the use of GLP‐1As was safe and well tolerated in patients with cirrhosis, but the side effects of gastrointestinal disorders such as nausea and constipation may occur.…”

Section: Discussionmentioning

confidence: 99%

Trends in risk factor control and treatment among patients with non‐alcoholic fatty liver disease and type 2 diabetes between 2000 and 2020: A territory‐wide study

Zhang

Yip

Tse

et al. 2023

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Background & Aims: We aimed to determine the trends in risk factor control and treatment among patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) in 2000-2020. Methods: We conducted a territory-wide cohort study of adult patients with NAFLD and T2D diagnosed between 1 January 2000 and 31 July 2021 in Hong Kong. T2D was defined by use of any anti-diabetic agents, laboratory tests and/or diagnosis codes. Results: This study included 16,084 patients with NAFLD and T2D (mean age, 54.8 ± 12.0 years; 7124 male [44.3%]). The percentage of patients achieving individualised haemoglobin A 1c (HbA 1c ) targets increased from 44.5% (95% confidence interval [CI], 42.9-46.1) to 64.8% (95% CI, 64.1-65.5), and percentage of patients achieving individualised low-density lipoprotein-cholesterol (LDL-C) targets increased from 23.3% (95% CI, 21.9-24.7) to 54.3% (95% CI, 53.5-55.1) from 2000-2005 to 2016-2020, whereas percentage of patients achieving blood pressure control (<140/90 mm Hg) remained static at 53.1-57.2%. Combination therapy for

show abstract

“…Multiple studies have found that SGLT2I lowered the risk of NAFLD with pathological reductions of steatosis on histological examinations [13, 39-41]. In one study, SGLT2I reduced the risk for death and improved the survival of T2DM veterans with cirrhosis when compared to DPP4I [42]. Furthermore, SGLT2I also reduced the body mass index significantly and reduced the hepatocarcinogenesis for NAFLD [43].…”

Section: Discussionmentioning

confidence: 99%

Lower risks of sodium glucose cotransporter 2 (SGLT2) inhibitors compared to dipeptidyl peptidase-4 (DPP4) inhibitors for new-onset non-alcoholic fatty liver disease and hepatocellular carcinoma in type 2 diabetes mellitus: A population-based study

Chou

Ning

Chan

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The association between sodium glucose cotransporter 2 inhibitors (SGLT2I) versus dipeptidyl peptidase-4 inhibitors (DPP4I) and the risks of non-alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) are currently unknown. Methods: This was a retrospective population-based cohort study including type-2 diabetes mellitus (T2DM) patients treated with either SGLT2I or DPP4I between 1st January 2015 and 31st December 2019 in Hong Kong. Patients with concurrent DPP4I and SGLT2I usage were excluded. The primary outcomes were NAFLD and HCC. The secondary outcomes included cancer-related mortality and all-cause mortality. Propensity score matching (1:1 ratio) was performed using the nearest neighbour search. Univariable and multivariable Cox regression was applied to identify significant predictors. Competing risks models and multiple approaches using the propensity score were performed. Results: This cohort included 62699 patients with T2DM, amongst which 22154 patients were on SGLT2I and 40545 patients were on DPP4I. After matching (44308 patients), 1090 patients developed new-onset NAFLD (Incidence: 4.6; 95% Confidence interval [CI]: 4.3-4.9) and 187 patients developed HCC (Incidence: 0.8; 95% CI: 0.7-0.9). Overall, SGLT2I was associated with lower risks of NAFLD (Hazard ratio [HR]: 0.39; 95% CI: 0.34-0.46), and HCC (HR: 0.46; 95% CI: 0.29-0.72) compared to DPP4I after adjustments. SGLT2I was also associated with lower risks of cancer-related mortality (HR: 0.29; 95% CI: 0.23-0.37) and all-cause mortality (HR: 0.28; 95% CI: 0.25-0.31). However, amongst patients with hepatitis B virus infection, SGLT2I was associated with higher risks of HCC (HR: 3.28; 95% CI: 1.21-8.90). The results were consistent in competing risk models and different matching approaches. Conclusion: SGLT2I was associated with lower risks of NAFLD, and HCC compared to DPP4I after propensity scores matching and adjustments.

show abstract

Impact of SGLT2 inhibitors in comparison with DPP4 inhibitors on ascites and death in veterans with cirrhosis on metformin

Cited by 14 publications

References 23 publications

Diabetes and cirrhosis: Current concepts on diagnosis and management

Diabetes and cirrhosis: Current concepts on diagnosis and management

Trends in risk factor control and treatment among patients with non‐alcoholic fatty liver disease and type 2 diabetes between 2000 and 2020: A territory‐wide study

Lower risks of sodium glucose cotransporter 2 (SGLT2) inhibitors compared to dipeptidyl peptidase-4 (DPP4) inhibitors for new-onset non-alcoholic fatty liver disease and hepatocellular carcinoma in type 2 diabetes mellitus: A population-based study

Contact Info

Product

Resources

About