Sodium-Glucose Cotransporter 2 Inhibitors Versus Dipeptidyl Peptidase-4 Inhibitors in Patients With Type 2 Diabetes Mellitus and Liver Cirrhosis: A Systematic Review and Meta-Analysis
Abstract
Liver cirrhosis complicated by type 2 diabetes mellitus (T2DM) is associated with significantly increased risks of hepatic decompensation, infection, and mortality. The optimal antidiabetic strategy in this population remains poorly defined, with limited evidence directly comparing available agents. This meta-analysis compared the clinical effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with established liver cirrhosis. A systematic search of MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science was conducted up to 15 April 2026. Four retrospective observational cohort studies enrolling 25,000 patients with established cirrhosis and T2DM were included. All-cause mortality showed a pooled risk ratio of 0.64 (95% CI: 0.34-1.23; I2 = 89.1%), hepatic decompensation RR 0.75 (95% CI: 0.49-1.16; I2 = 84.9%), ascites HR 0.85 (95% CI: 0.55-1.29; I2 = 0.0%), oesophageal variceal bleeding RR 0.88 (95% CI: 0.59-1.30; I2 = 12.8%), and hepatic encephalopathy RR 0.89 (95% CI: 0.03-23.05; I2 = 83.4%). None of the pooled estimates reached statistical significance, largely attributable to the small number of contributing studies and substantial heterogeneity driven by aetiological diversity across cohorts. These results suggest that SGLT2i may be preferable to DPP4i in patients with compensated cirrhosis requiring antidiabetic intensification, though prospective randomised trials are needed to confirm this…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 25,000 participants or records.
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