A new study from Cleveland Clinic researchers suggests that sodium-glucose co-transporter-2 (SGLT2) inhibitors are safe for patients with cirrhosis and may reduce the risk of severe complications and mortality. The retrospective study, presented at the annual meeting of the American College of Gastroenterology, offers a potential new avenue for managing diabetes and related complications in patients with severe liver disease.
The research addresses a significant clinical challenge, as many medications are contraindicated for individuals with severe liver disease, leading to a lack of evidence-based treatment options. Patients with cirrhosis often experience serious complications, including fluid buildup, variceal bleeding, and electrolyte imbalances, creating an unmet need for effective therapies.
Study Design and Findings
The study, which utilized data from the TriNetX database, compared outcomes in 4,931 cirrhosis patients prescribed an SGLT2 inhibitor along with spironolactone and furosemide, against a matched cohort receiving only spironolactone and furosemide. The results indicated that SGLT2 inhibitors were not only safe in this population but also associated with a significantly reduced risk of all-cause mortality, hospitalization, and serious liver-related events.
Specifically, the SGLT2i group experienced a lower incidence of complications such as hyponatremia, ascites, and variceal bleeding. Interestingly, the study also noted a decreased incidence of hypoglycemia in the SGLT2i group, a surprising but welcome finding given the complexity of managing diabetes in cirrhosis patients.
Expert Commentary
"Patients who suffer from liver disease, including cirrhosis, may have physiology changes that require additional consideration when choosing the right medication to control their diabetes," said Dr. Dian Chiang, a gastroenterologist at Cleveland Clinic’s Digestive Disease Institute and co-author of the study. "Physicians should consider this type of medication favorably because it seems to be associated with additional benefits beyond just blood glucose control."
Future Research
The research team is planning further investigations to delve deeper into these findings. A retrospective study will examine outcomes in greater detail, considering the underlying cause of cirrhosis and comparing the effectiveness of different SGLT2i medications. Additionally, a prospective study is planned to validate the findings using the most promising SGLT2i drug.
