Comparative effectiveness of sodium‐glucose co‐transporter‐2 inhibitors and dipeptidyl peptidase‐4 inhibitors on liver function in patients with type 2 diabetes in Japan: A real‐world data analysis

Dec 12, 2023Diabetes, obesity & metabolism

Comparing effects of two diabetes drugs on liver health in Japanese patients with type 2 diabetes

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Abstract

Patients receiving an SGLT2 inhibitor had significantly greater reductions in alanine aminotransferase (ALT) compared to those receiving a DPP4 inhibitor.

SGLT2 inhibitors resulted in larger decreases in ALT, Fibrosis-4 index, and gamma-glutamyl transpeptidase (GGT) compared to DPP4 inhibitors.
A significant increase in albumin levels was observed in patients treated with SGLT2 inhibitors.
In subgroups with lower baseline Fibrosis-4 index and HbA1c, the SGLT2 inhibitor group showed a greater change in ALT than the DPP4 inhibitor group.
The findings suggest that SGLT2 inhibitors may offer hepatoprotective benefits and potentially prevent liver fibrosis in patients with type 2 diabetes.

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AIM: To compare the effects of sodium-glucose co-transporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) on liver function in patients with type 2 diabetes (T2D) in Japan.

MATERIALS AND METHODS: This was a Japanese retrospective cohort study using the RWD Database (1 January 2015 to 24 September 2021). Patients newly treated with an SGLT2i or a DPP4i were matched 1:4 (SGLT2i:DPP4i) using propensity score. The primary endpoint was the change from baseline to 1 year after the index date in alanine aminotransferase (ALT). Secondary endpoints included change from baseline in various laboratory test results, including the Fibrosis-4 (FIB-4) index, aspartate aminotransferase, gamma-glutamyl transpeptidase (GGT), albumin and HbA1c. Endpoints were compared between treatment groups using Welch's t-test in the full population and in subgroups stratified by baseline characteristics.

RESULTS: Baseline characteristics of 955 and 3063 matched patients newly treated with an SGLT2i and a DPP4i, respectively, were well balanced. Patients receiving an SGLT2i had significantly greater reductions in ALT, FIB-4 index and GGT and a significantly greater increase in albumin than patients receiving a DPP4i. A significantly greater change from baseline in ALT was observed in the SGLT2i group than in the DPP4i group among subgroups with lower baseline FIB-4 index and HbA1c.

CONCLUSIONS: In this study, improvements in various measures, including ALT, the FIB-4 index, GGT and albumin, were observed with SGLT2is compared with DPP4is, suggesting that SGLT2is may provide hepatoprotective benefits, including the prevention of liver fibrosis, in patients with T2D in Japan.

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Comparative effectiveness of sodium‐glucose co‐transporter‐2 inhibitors and dipeptidyl peptidase‐4 inhibitors on liver function in patients with type 2 diabetes in Japan: A real‐world data analysis

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