Anirvan P, Giri S, Malakar S, Praharaj DL. Role of sodium-glucose cotransporter 2 inhibitors in liver diseases. World J Exp Med 2025; 15(4): 106403 [DOI: 10.5493/wjem.v15.i4.106403]
Corresponding Author of This Article
Suprabhat Giri, DM, MD, Associate Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5 KIIT Rd, Patia, Bhubaneswar 751024, Odisha, India. supg19167@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Prajna Anirvan, Department of Gastroenterology, Institute of Medical Sciences and SUM Hospital Campus II, Bhubaneswar 754001, Odisha, India
Suprabhat Giri, Dibya Lochan Praharaj, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Sayan Malakar, Department of Gastroenterology, King George Medical University, Lucknow 226003, Uttar Pradesh, India
Co-first authors: Prajna Anirvan and Suprabhat Giri.
Author contributions: Giri S and Praharaj DL contributed to the conception and design of the manuscript; All authors contributed to the literature review, analysis, data collection, interpretation, and critical revision of the initial manuscript; Anirvan P, Malakar S and Giri S drafted the initial manuscript; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Suprabhat Giri, DM, MD, Associate Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5 KIIT Rd, Patia, Bhubaneswar 751024, Odisha, India. supg19167@gmail.com
Received: February 25, 2025 Revised: April 28, 2025 Accepted: August 13, 2025 Published online: December 20, 2025 Processing time: 297 Days and 11.9 Hours
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors compete with the SGLT2 protein for glucose binding in the renal tubules, reducing glucose reabsorption in the kidneys. This in turn leads to increased excretion of glucose, sodium, and water into the urine. These inhibitors, initially developed for diabetes management, have shown potential benefits beyond glycemic control, impacting liver health through various mechanisms. They have emerged as promising agents in managing liver conditions, including fatty liver disease, cirrhosis, and the prevention of hepatocellular carcinoma (HCC). They modulate processes like oxidative stress, inflammation, and autophagy, which are implicated in metabolic dysfunction-associated steatotic liver disease pathogenesis, potentially reducing steatosis and inflammation and preventing progression to more severe liver conditions. In patients with liver cirrhosis, SGLT2 inhibitors have been associated with a reduced need for large-volume paracentesis and lower mortality rates, indicating their potential in managing diuretic-resistant ascites. SGLT2 inhibitors have shown potential in modulating molecular pathways involved in HCC, such as inflammatory responses and oxidative stress, that could justify their use in the prevention of HCC and improving survival in patients with HCC. The present review synthesized findings from multiple studies to elucidate the role of SGLT2 inhibitors in these liver conditions.
Core Tip: Sodium-glucose cotransporter 2 inhibitors, primarily developed for diabetes, have shown potential benefits in managing liver conditions. Studies report improved liver enzymes, lipid profile, insulin sensitivity, and stiffness in steatotic liver disease. In patients with decompensated cirrhosis of the liver with refractory ascites, sodium-glucose cotransporter 2 inhibitors reduce the need for paracentesis due to their natriuretic and diuretic effects. Emerging evidence also suggests a role in preventing hepatocellular carcinoma. However, associated adverse events necessitate careful consideration. Further research is crucial to fully understand their mechanisms, optimize treatment strategies, and establish clear clinical guidelines, especially regarding the benefit-risk ratio and combination therapies.
