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Front Endocrinol (Lausanne). 2021;12:613389.

Sodium-Glucose Cotransporter-2 Inhibitors Ameliorate Liver Enzyme Abnormalities in Korean Patients With Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease.

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제1저자 어원, 임수 · 교신저자 김진욱

소속 (2)
  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
  2. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are reported to reduce body fat in patients with type 2 diabetes mellitus (T2DM), and SGLT2i-induced weight reduction may help improve comorbid nonalcoholic fatty liver disease (NAFLD). This study aimed to investigate the potential benefit of SGLT2is over other oral antidiabetic drugs (OADs) in patients with T2DM-associated NAFLD. We enrolled real-world Korean patients with T2DM-associated NAFLD in whom initial metformin therapy had been modified by stepwise addition of OAD(s) due to insufficient glucose control. Propensity score (PS) matching was used for the comparison of changes in clinical and biochemical parameters to balance potential covariates. Among the 765 enrolled patients, 663 patients received additional OADs other than SGLT2i and 102 patients received SGLT2i therapy. PS matching selected 150 and 100 patients from the control and the SGLT2i group, respectively. The SGLT2i group lost more weight than the control group at 6 months (mean -1.3 kg vs. 0.0 kg; P < 0.001). Alanine aminotransferase (ALT) levels also decreased more in the SGLT2i group at 3 (-11 U/L vs. -1 U/L), 6 (-12 U/L vs. -1 U/L), and 12 months (-14 U/L vs. -2 U/L) (all P < 0.05). Addition of SGLT2is was an independent predictor of ALT improvement in a multivariate logistic regression model (odds ratio 1.91; P = 0.016). Compared with other OADs, addition of SGLT2is was more effective in weight reduction and ALT improvement in patients with T2DM and comorbid NAFLD.

Copyright © 2021 Euh, Lim and Kim.

Keywords

alanine aminotransferasebody weightpropensity score (PS) matching (PSM)sodium-glucose cotransporter 2 (SGLT2) inhibitortype 2 diabetes mellitus

Figures

Figure 1
Figure 1 Flowchart of the selection process. *Other liver diseases included viral hepatitis B and C, autoimmune hepatitis, drug-induced liver injury, and history of excessive alcohol intake (daily intake > 30 g for men and > 20 g for women). GLP-1, glucagon-like peptide-1; US, ultrasound; SGLT2i, sodium-glucose cotransporter-2 inhibitor.
Figure 2
Figure 2 Sensitivity analysis of odds ratio of SGLT2is for managing ALT levels. This Forest plot indicates the odds ratio of SGLT2i over control for the endpoint of ALT decrease ≥ 15% of baseline values. The benefit of SGLT2i for ALT decrease was more prominent in younger patients, male sex, high baseline BMI, and patients with less weight reduction.

그림 출처: PubMed Central 공개 논문 (PMC8222919)

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
Frontiers in endocrinology · ISSN 1664-2392
전자 출판
2021-06-10
MeSH
Adult · Aged · Aged, 80 and over · Alanine Transaminase / blood · Aspartate Aminotransferases / blood · Blood Glucose · Diabetes Mellitus, Type 2 / blood / drug therapy / enzymology · Female · Humans · Hypoglycemic Agents / pharmacology / therapeutic use · Liver / drug effects / enzymology · Male · Middle Aged · Non-alcoholic Fatty Liver Disease / blood / drug therapy / enzymology · Republic of Korea · Retrospective Studies · Risk Factors · Sodium-Glucose Transporter 2 Inhibitors / pharmacology / therapeutic use · Triglycerides / blood
Substances
Blood Glucose · Hypoglycemic Agents · Sodium-Glucose Transporter 2 Inhibitors · Triglycerides · Aspartate Aminotransferases · Alanine Transaminase
참고문헌
49편