SGLT2 Inhibitors Tied to Lower Risk in Patients with Diabetes and Cirrhosis

A rigorous cohort study utilizing Taiwan’s National Health Insurance Database provides robust evidence that SGLT2 inhibitors offer superior multi-organ protection for the complex population of patients with both type 2 diabetes and liver cirrhosis. Among 24,259 adults (average age 64.7 years; 33.9% female) followed for a median of 2.3 years, those initiating SGLT2is—including dapagliflozin, empagliflozin, and canagliflozin—showed significantly better outcomes compared to those starting DPP4is. After balancing baseline characteristics using inverse probability of treatment weighting, SGLT2i use was associated with a striking 66% relative risk reduction for end-stage kidney disease (adjusted HR, 0.34) and a 34% reduction for acute kidney injury (adjusted HR, 0.66). Cardiovascular benefits were also substantial, with a 33% lower risk of major adverse cardiovascular events (adjusted HR, 0.67) driven by reductions in its individual components. Notably, the protective effects extended to the liver, where SGLT2i use correlated with a 35% lower risk of hepatic decompensation events (adjusted HR, 0.65) and a 42% reduction in all-cause mortality (adjusted HR, 0.58). These findings suggest that for this high-risk group, SGLT2 inhibitors should be strongly considered as the preferred antidiabetic therapy to safeguard kidney, heart, and liver health. Source: https://jamanetwork.com/