Can SGLT2 inhibitors prevent liver disease for people with diabetes?

This review looked at whether sodium-glucose cotransporter 2 (SGLT2) inhibitors can improve non-alcoholic fatty liver disease (NAFLD) for people with type 2 diabetes (T2D). It found that these medications can improve liver function in these patients.

NAFLD is a condition in which fat builds up in the liver. This makes the liver less able to perform its normal functions such as breaking down wastes. A buildup of fat in the liver can happen when the body does not respond well to the hormone insulin. Because T2D is also related to insulin resistance, T2D and NAFLD often occur together.

SGLT2 inhibitors are a group of diabetes medications. SGLT2 inhibitors include canagliflozin (Invokana) and empagliflozin (Jardiance). These medications affect the kidneys, causing glucose to pass out of the body in the urine. SGLT2 inhibitors also reduce kidney damage, which can be a complication of T2D. Some studies have found SGLT2 inhibitors may improve liver function for people with T2D and NAFLD. Research is ongoing into how SGLT2 inhibitors affect fatty liver in these patients.

This review included 10 studies of 573 people with T2D and NAFLD. All the studies assigned patients to either an SGLT2 inhibitor or another treatment. These other treatments included metformin (Glucophage), exenatide (Byetta), or other glucose-lowering medications prescribed by their doctor.

Glycated hemoglobin (HbA1c) indicates glucose control over the previous two to three months. SGLT2 inhibitors improved HbA1c similarly to other diabetes medications.

Blood tests of liver enzyme levels can indicate liver health. SGLT2 inhibitors improved liver enzyme levels significantly more than other diabetes medications. SGLT2 inhibitors also led to more improvement than pioglitazone (Actos) specifically.

SGLT2 inhibitors significantly improved body weight compared to other diabetes medications. They also reduced body fat in the abdomen, which can improve the health of the internal organs.

This review found that SGLT2 inhibitors led to better liver function than other medications for people with T2D and NAFLD.

This review could not compare SGLT2 inhibitors to many other specific types of diabetes medications. More studies are needed.