SGLT2I has an edge over DPP4I in lowering risk of NAFLD, and HCC among diabetes patients

Sodium-glucose cotransporter 2 inhibitors (SGLT2I) have a low risk of non-alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) in comparison to dipeptidyl peptidase-4 inhibitors (DPP4I) as per a study that was preprinted in medRxiv. 

Type 2 diabetics have an increased propensity to develop Hepatocellular carcinoma and certain antidiabetic medications have a protective effect against it. But there is not much research on the association between sodium-glucose cotransporter 2 inhibitors (SGLT2I) versus dipeptidyl peptidase-4 inhibitors (DPP4I) and the risks of non-alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC). Hence, researchers conducted a retrospective population-based cohort study in Hong Kong between 1st January 2015 and 31st December 2019. Patients having type-2 diabetes mellitus (T2DM) patients and under SGLT2I or DPP4I but not on concurrent DPP4I and SGLT2I usage were included in the study. NAFLD and HCC were the primary outcomes of measurement while the secondary outcomes were cancer-related mortality and all-cause mortality.  Propensity score matching (1:1 ratio) was performed using the nearest Neighbour search. Univariable and multivariable Cox regression was applied to identify significant predictors. Competing risk models and multiple approaches using the propensity score were performed. 

Results:

• This cohort included 62699 patients with T2DM. Among these 22154 patients were on SGLT2I and 40545 patients were on DPP4I.
• After matching, 1090 patients developed new-onset NAFLD, and 187 patients developed HCC.
• Overall, SGLT2I was associated with lower risks of NAFLD, and HCC compared to DPP4I after adjustments.
• SGLT2I was also associated with lower risks of cancer-related mortality and all-cause mortality.
• However, amongst patients with hepatitis B virus infection, SGLT2I was associated with higher risks of HCC.
• The results were consistent in competing for risk models and different matching approaches.  

Thus, the researchers concluded from the study that SGLT2I was associated with lower risks of NAFLD, and HCC compared to DPP4I after propensity scores matching and adjustments. 

To read the full article, click here: https://doi.org/10.1101/2022.08.16.22278847 (This article is a preprint and has not been peer-reviewed.)