SGLT2 Inhibitors tied to Superior Cardiorenal and Hepatic Outcomes in Diabetes patients With Cirrhosis: JAMA

A recent study published in the Journal of the American Medical Association revealed that the use of sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) was associated with markedly lower risks of adverse kidney, cardiovascular, and hepatic outcomes compared with dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) in patients with type 2 diabetes (T2D) and liver cirrhosis. The findings suggests meaningful cardiorenal and hepatic protection in this high-risk population.

Patients with both diabetes and cirrhosis represent a particularly fragile population, where diabetes accelerates organ damage and cirrhosis limits the body’s ability to metabolize medications safely. And so, physicians face uncertainty about which glucose-lowering drugs provide the best balance between effectiveness and safety. Thus, this study evaluated the use of SGLT2 inhibitors in in patients with type 2 diabetes and liver cirrhosis which is associated with improved cardiorenal and hepatic outcomes.

This research analyzed health records from Taiwan and found that SGLT2 inhibitors were associated with substantially better outcomes than DPP-4 inhibitors. The findings highlight a potential shift in treatment strategies for patients whose dual diagnoses make medication choices particularly complex.

This retrospective cohort study used data from the Taiwan National Health Insurance database and included more than 24,000 adults diagnosed with both type 2 diabetes and liver cirrhosis from 2016 to 2023. The participants began treatment with either SGLT2 inhibitors or DPP-4 inhibitors and were monitored for a median follow-up period of slightly over 2 years.

When compared with DPP-4 inhibitor users, the individuals on SGLT2 therapy had a 66% lower risk of progressing to end-stage kidney disease and a 34% lower risk of acute kidney injury. Cardiovascular outcomes also improved, with a 33% reduction in major adverse cardiovascular events like myocardial infarction and stroke.

SGLT2 inhibitor use was associated with a 42% reduction in all-cause mortality. The treatment group also experienced significantly lesser episodes of hepatic decompensation which leads to complications like ascites or hepatic encephalopathy.

Overall, the findings of this study found that SGLT2 inhibitors may offer meaningful cardiorenal and hepatic protection for patients managing both conditions. Additional randomized clinical trials will be needed to confirm the findings, but the results already provide encouraging evidence in patients facing the combined burden of diabetes and liver cirrhosis.

Reference:

Chung, M.-C., Yu, T.-M., Wu, L.-Y., Wu, M.-J., Shieh, J.-J., & Chung, C.-J. (2026). SGLT2 inhibitor use and cardiorenal outcomes in type 2 diabetes with liver cirrhosis. JAMA Network Open, 9(2), e2560429. https://doi.org/10.1001/jamanetworkopen.2025.60429