SGLT2 inhibitors suitable for patients with T2D and NAFLD

Clinicians may favour prescribing sodium-glucose cotransporter 2 (SGLT2) inhibitors to patients with both type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD), with the drugs having potential benefits in terms of NAFLD regression and reduced incidences of adverse liver-related outcomes, according to a study.

For the retrospective nonrandomized interventional cohort study, researchers used the National Health Information Database, which provided population-level data for Korea. A total of 80,178 patients with T2D and concomitant NAFLD (mean age 58.5 years, 53.6 percent male) were included in the analysis. Patients received either SGLT2 inhibitors, thiazolidinediones, dipeptidyl peptidase-4 (DPP-4) inhibitors, or sulfonylureas, each combined with metformin for at least 80 percent of 90 consecutive days.

Study outcomes included NAFLD regression (evaluated using the fatty liver index) and composite liver-related outcome (defined as liver-related hospitalization, liver-related mortality, liver transplant, and hepatocellular carcinoma). The Fine-Gray model was applied to factor in competing risks.

Over 219,941 person-years of follow-up, 4,102 patients achieved NAFLD regression. SGLT2 inhibitors were associated with NAFLD regression compared with sulfonylureas (adjusted subdistribution hazard ratio [ASHR], 1.99, 95 percent CI, 1.75–2.27). The same held true for thiazolidinediones (ASHR, 1.70, 95 percent CI, 1.41–2.05) and DPP-4 inhibitors (ASHR, 1.45, 95 percent CI, 1.31–1.59).

On further analysis, patients on SGLT2 inhibitors had about a 40-percent higher likelihood of NAFLD regression compared with those on thiazolidinediones (ASHR, 1.40, 95 percent CI, 1.12–1.75) and DPP-4 inhibitors (ASHR, 1.45, 95 percent CI, 1.30–1.62).

Finally, SGLT2 inhibitors were significantly associated with lower incidence rates of adverse liver-related outcomes compared with sulfonylureas (ASHR, 0.37, 95 percent CI, 0.17–0.82). This benefit was not observed for thiazolidinediones and DPP-4 inhibitors.