SGLT2 Inhibitor Use and Cardiorenal Outcomes in Type 2 Diabetes With Liver Cirrhosis
Abstract
IMPORTANCE: Type 2 diabetes (T2D) and liver cirrhosis frequently coexist, creating a high-risk population for adverse outcomes. Patients with both conditions face elevated risks of kidney and cardiovascular complications, yet evidence regarding optimal antidiabetic therapy in this vulnerable population remains limited.
OBJECTIVE: To evaluate the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) vs dipeptidyl peptidase-4 inhibitor (DPP4i) use with kidney outcomes, cardiovascular events, and hepatic decompensation in patients with concurrent T2D and liver cirrhosis.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide retrospective cohort study utilized data from the Taiwan's National Health Insurance Database between May 2016 and December 2023. Adults with both T2D and liver cirrhosis who initiated either SGLT2is or DPP4is were included.
EXPOSURE: Use of SGLT2is (dapagliflozin, empagliflozin, and canagliflozin) or DPP4is (alogliptin, linagliptin, sitagliptin, saxagliptin, and vildagliptin).
MAIN OUTCOMES AND MEASURES: The primary outcomes were end-stage kidney disease (ESKD), acute kidney injury (AKI), and major adverse cardiovascular events (MACE). Secondary outcomes included individual MACE components and hepatic decompensation events. Inverse probability of treatment weighting was employed to balance baseline characteristics.
RESULTS: Among 24 259 patients (mean [SD] age, 64.68 [11.95] years; 8229 female [33.92%]), 9689 (39.94) received SGLT2is and 14 570…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 24 participants or records.
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