From kidney to liver: Are sodium–glucose cotransporter-2 inhibitors emerging as metabolic disease modifiers?

Table 1 Summary of selected studies

Ref.	Study type	Follow-up period	Population	Intervention/comparison	Confounders	Conclusions
Cho et al[16], 2024 (Republic of Korea)	Retrospective cohort	Median follow-up 3.56 years	Type 2 diabetes patients with MASLD	SGLT2 inhibitors compared to OGLD	Comorbid viral hepatitis	SGLT2i may be a beneficial option for diabetes management in patients with T2DM, MASLD, and chronic viral hepatitis (risk ratio: 0.54, 95%CI: 0.41-0.70)
Shen et al[17], 2024 (United States)	Retrospective cohort	January 2014-December 2022 (9 years)	Patients with T2DM and MASLD	Metformin and SGLT2 inhibitors compared to DPP4 inhibitors	Concurrent metformin use	No significant difference in the incidence of HCC between the two groups (risk ratio: 0.75, 95%CI: 0.53-1.04)
Mao et al[18], 2024 (United States)	Retrospective cohort	April 2013-December 2021 (8 years)	Patients with T2DM and MASLD	SGLT2 inhibitors compared to other oral hypoglycemic drugs	Other patients were also taking metformin	SGLT2 inhibitor users were associated with a substantially lower risk of HCC than OGLD users among patients with diabetic MASLD (risk ratio: 0.60, 95%CI: 0.49-0.73). The risk was further reduced with concomitant metformin use

SGLT2: Sodium-glucose cotransporter-2; MASLD: Metabolic dysfunction–associated steatotic liver disease; HCC: Hepatocellular carcinoma; T2DM: Type 2 diabetes mellitus; OGLD: Other glucose-lowering drugs.