GLP-1 receptor agonists and SGLT-2 inhibitors significantly reduced major cardiovascular events and serious liver complications in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease, according to research presented at ENDO 2024, the Endocrine Society's annual meeting in Boston, Mass.
The study assessed the comparative cardiovascular and hepatic effectiveness and safety of GLP-1 receptor agonists (GLP-1 RA) and sodium–glucose cotransporter 2 inhibitors (SGLT-2i) in people with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD).
"Our study shows that GLP-1 receptor agonists and SGLT-2 inhibitors are more beneficial in preventing heart-related events compared to dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors), and GLP-1 RAs also help reduce severe liver events," said lead researcher Alexander Kutz, M.D. "Before this study, there was limited information about how these specific diabetes medications work in patients with both type 2 diabetes and MASLD."
Data from Medicare and a large U.S. health insurance database were used to conduct two propensity-score fine stratification weighted cohort studies. The study included adults with type 2 diabetes and MASLD who initiated GLP-1 RA, SGLT-2i, or DPP-4 inhibitors.
The primary cardiovascular outcome was a composite of acute myocardial infarction, ischemic stroke, hospitalization for heart failure, or all-cause mortality. The primary hepatic outcome was a composite of serious liver events, including hospitalization for ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, bleeding esophageal varices, hepatic encephalopathy, or liver transplantation.
Compared with DPP-4 inhibitors, the use of GLP-1 receptor agonists was associated with a 33% lower risk of major cardiovascular events and a 53% lower risk of serious liver events. The use of SGLT-2 inhibitors was associated with an 18% lower risk of major cardiovascular events compared to DPP-4 inhibitors, although the reduction in serious liver events was not statistically significant.
"Our findings suggest that GLP-1 receptor agonists and SGLT-2 inhibitors may be more beneficial than other diabetes medications for patients with type 2 diabetes and MASLD," Kutz said. "Using these drugs reduces the risk of heart-related events and serious liver complications, potentially leading to fewer hospitalizations and improved health outcomes."
The researchers noted that severe adverse events were not more frequent with GLP-1 RAs or SGLT-2is compared to DPP-4 inhibitors, indicating a favorable safety profile for these medications.
No conflicts of interest were disclosed.