Sodium-glucose cotransporter-2 inhibitors were associated with lower risks of kidney, cardiovascular, and hepatic complications among patients with type 2 diabetes and cirrhosis in a nationwide cohort study.

Researchers analyzed data from Taiwan’s National Health Insurance Research Database to compare outcomes among patients with both conditions who initiated either sodium-glucose cotransporter-2 inhibitors or dipeptidyl peptidase-4 inhibitors between 2016 and 2023. The final cohort included 24,259 patients, of whom 9,689 received a sodium-glucose cotransporter-2 inhibitor and 14,570 received a dipeptidyl peptidase-4 inhibitor.

Patients had a mean age of 64.7 years, and about two-thirds were male. Over a median follow-up of 2.3 years, researchers tracked several outcomes, including end-stage kidney disease, acute kidney injury, major adverse cardiovascular events, and hepatic decompensation.

After adjustment for baseline characteristics and comorbidities, treatment with sodium-glucose cotransporter-2 inhibitors was associated with a substantially lower risk of end-stage kidney disease. The risk of acute kidney injury was also lower compared with dipeptidyl peptidase-4 inhibitors.

Major adverse cardiovascular events—including myocardial infarction, stroke, heart failure, and all-cause mortality—were less common among patients receiving sodium-glucose cotransporter-2 inhibitors.

Researchers also observed fewer hepatic decompensation events—including ascites, peritonitis, and esophageal variceal bleeding—among patients receiving sodium-glucose cotransporter-2 inhibitors. These associations remained consistent across multiple subgroup and sensitivity analyses, including a propensity-matched cohort.

The study population reflected the diverse causes of cirrhosis in Taiwan, including viral hepatitis, alcohol-related liver disease, and metabolic liver disease.

The researchers noted several limitations. Laboratory data—including measures of cirrhosis severity—were unavailable in the administrative database, and residual confounding cannot be fully excluded despite statistical adjustment.

The researchers suggested that sodium-glucose cotransporter-2 inhibitors may provide cardiorenal and hepatic benefits for patients with type 2 diabetes and cirrhosis, although prospective studies are needed to confirm these associations.

The researchers reported no conflicts of interest.

Source: JAMA Network Open