SGLT2 Inhibitors: A New Dawn for Recurrent/Refractory Cirrhotic Ascites

Gao, Yuan; Wei, Lai; Zhang, Dorothy Da; Chen, Yu; Hou, Bing

doi:10.14218/jcth.2021.00418

Cited by 13 publications

(6 citation statements)

References 10 publications

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“…Overall, detection and treatment of diabetes generally follow usual diabetes guidelines, however, in patients with advanced liver cirrhosis, HbA1c may not be a reliable marker of average glucose levels [98,99], and treatment with insulin is generally recommended [45][46][47][48][49]. In addition, SGLT-2 inhibitors have recently been suggested to be beneficial in treating refractory ascites [113][114][115]. Further research on diabetes risk in autoimmune liver disease is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…In any case, close monitoring of blood glucose is necessary as insulin sensitivity and metabolization within the liver may vary with varying degrees of reduced liver function increasing the risk of hypo-and hyper-glycaemia during insulin treatment [47][48][49]. In addition, it has recently been suggested that sodium-glucose cotransporter 2 (SGLT-2) inhibitors may be a beneficial treatment in patients with cirrhosis and refractory ascites because of their diuretic properties [113][114][115]. Promising results have been demonstrated in case reports [116][117][118], and with SGLT-2 inhibitors demonstrating beneficial effects in patients with chronic heart failure [119,120] and chronic kidney disease [121,122] even without diabetes, elucidation of their potential effects in cirrhotic patients with refractory ascites, including those without diabetes, is warranted.…”

Section: Diabetes Treatment In Autoimmune Liver Diseasementioning

confidence: 99%

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Autoimmune liver diseases and diabetes

Jensen

Ytting

Winther-Sørensen

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Autoimmune liver diseases include autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. They are chronic, heterogenous diseases affecting the liver which is a key metabolic organ that ensures glucose homeostasis. It is well known that patients with other chronic liver diseases such as cirrhosis and nonalcoholic fatty liver disease (NAFLD) display glucose disturbances like insulin resistance and have an increased risk of diabetes. Previous evidence on glucose disturbances in patients with autoimmune liver disease is scarce but does point towards a potentially increased risk of type 1 diabetes and type 2 diabetes. The underlying mechanisms are unknown but may reflect genetic predisposition, concurrent NAFLD and or cirrhosis development, and treatment (steroid) related impairment of glucose homeostasis. Therefore, increased awareness and surveillance of diabetes development in patients with autoimmune liver disease may be important. Overall, detection and treatment of diabetes generally follow the usual diabetes guidelines; however, in patients with advanced liver cirrhosis, HbA1c may not be a reliable marker of average glucose levels, and treatment with insulin is generally recommended. In addition, it has recently been suggested that sodium–glucose cotransporter 2 inhibitors may be beneficial in treating refractory ascites. Further research on diabetes risk in autoimmune liver disease is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Diabetes Treatment In Autoimmune Liver Diseasementioning

confidence: 99%

Autoimmune liver diseases and diabetes

Jensen

Ytting

Winther-Sørensen

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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“…The promising findings in the field of cardiometabolic medicine set the stage for future research to explore whether the benefits of gliflozins can expand to inpatients with non-cardiometabolic disorders. Considering encouraging preclinical data [ 48 , 49 ] and the wealth of mechanisms of action of these drugs, these could include, but are not restricted to, sepsis, cirrhotic ascites, and malignancies.…”

Section: Discussionmentioning

confidence: 99%

From Skepticism to Hope: The Evolving Concept of the Initiation and Use of Sodium-Glucose Cotransporter 2 Inhibitors in Hospitalized Patients

Koufakis

Mustafa

Ajjan

et al. 2022

Drugs

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The management of hyperglycemia in patients admitted to hospital is mainly based on insulin therapy. However, the positive and rapid effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiorenal outcomes raises the possibility that they might confer benefits to hospitalized patients. In recent, well designed, randomized trials (SOLOIST-WHF and EMPULSE) recruiting inpatients with heart failure (HF), SGLT2i demonstrated the potential to improve survival and quality of life and reduce the number of HF events, time to first HF event, hospitalizations, and urgent visits for HF compared with placebo. They were also well tolerated, whereas incidence of diabetic ketoacidosis was low. In EMBODY, empagliflozin was shown to be protective against the deleterious effects of cardiac injury in patients with acute myocardial infarction. In DARE-19, the administration of dapagliflozin to inpatients with cardiometabolic risk factors and COVID-19 was based on the hypothesis that the anti-inflammatory properties of SGLT2i could alleviate organ damage. Although the findings did not reach statistical significance, the efficacy and safety profiles of the drug were encouraging. These promising findings in the field of cardiometabolic medicine set the stage for future research to explore whether the benefits of gliflozins can expand to inpatients with non-cardiometabolic disorders, including sepsis, cirrhotic ascites, and malignancies. The concept of inpatient use of SGLT2i has evolved greatly over the past few years. The latest evidence suggests that SGLT2i may be effective and safe in the hospital setting, provided patients are carefully selected and closely monitored. Real-world data will prove whether present hope about inpatient use of gliflozins will transform into future confidence.

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“…11 It has also been speculated that their diuretic effects might be of great value for cirrhotic patients with refractory ascites. 12 Some anecdotal data retrieved from small case series support this hypothesis. 13 Regarding GLP-1RAs, a previous population-based retrospective cohort study found that treatment with this antidiabetic drug class resulted in a significant decrease in the risk of individual decompensation events, including ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, esophageal variceal hemorrhage, and hepatic encephalopathy.…”

Section: Jcth202200278mentioning

confidence: 95%