GLP-1 Agonists can reduce risk of mortality, liver failure in patients with type 2 diabetes and cirrhosis

The study showed a lower risk of cardiovascular disease, death, liver failure, hepatic encephalopathy, and decompensated cirrhosis in the users of GLP-1 receptor agonists. However, the researchers add that there is a need for additional studies to confirm their results.

Liver cirrhosis is often associated with type 2 diabetes, but research is scarce on type 2 diabetes (T2D) treatment in cirrhosis patients. To fill this knowledge gap, Chii-Min Hwu, National Yang-Ming Chiao Tung University, Taipei, Taiwan, and colleagues sought to investigate the long-term outcomes of glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes and cirrhosis.

For this purpose, the researchers selected 467 matched pairs of GLP-1 RA users and nonusers with T2D and compensated liver cirrhosis from the National Health Insurance Research Database of Taiwan using propensity-score matching from 2008 to 2019. Cardiovascular events, all-cause mortality, decompensated cirrhosis, and other key outcomes were compared between the two groups using multivariable-adjusted Cox proportional hazards models. The mean follow-up time was 3.06 years and 3.28 for GLP-1 RA nonusers and users, respectively.

The study revealed the following findings:

• The death rates were 27.46 and 55.90 per 1000 person-years for GLP-1 receptor agonists users and nonusers, respectively.
• The multivariable-adjusted models showed that GLP-1 RA users had lower risks of mortality (aHR 0.47), cardiovascular events (aHR 0.6), decompensated cirrhosis (aHR 0.7), hepatic encephalopathy (aHR 0.59), and liver failure (aHR 0.54) than nonusers.
• A longer cumulative duration of GLP-1 RA use had a lower risk of these outcomes than GLP-1 RA no-use.

"GLP-1 receptor agonists may be a treatment option for diabetes patients with liver cirrhosis," the researchers conclude. However, there is a need for further studies to confirm our results and explore the mechanisms of GLP-1 RAs, cirrhotic decompensation and hepatic encephalopathy."

The study's limitations were a lack of complete information on family history, body weight, diet, physical activity, biochemical tests, pathology, haemoglobin A1C, and imaging findings that could affect the results.

Reference:

Yen FS, Hou MC, Cheng-Chung Wei J, Shih YH, Hsu CY, Hsu CC, Hwu CM. Glucagon-like Peptide-1 Receptor Agonist Use in Patients With Liver Cirrhosis and Type 2 Diabetes. Clin Gastroenterol Hepatol. 2023 Jun 16:S1542-3565(23)00482-2. doi: 10.1016/j.cgh.2023.06.004. Epub ahead of print. PMID: 37331413.