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Liver cirrhosis complicated by type 2 diabetes mellitus (T2DM) is associated with significantly increased risks of hepatic decompensation, infection, and mortality. The optimal antidiabetic strategy in this population remains poorly defined, with limited evidence directly comparing available agents. This meta-analysis compared the clinical effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with established liver cirrhosis. A systematic search of MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science was conducted up to 15 April 2026. Four retrospective observational cohort studies enrolling 25,000 patients with established cirrhosis and T2DM were included. All-cause mortality showed a pooled risk ratio of 0.64 (95% CI: 0.34-1.23; I2 = 89.1%), hepatic decompensation RR 0.75 (95% CI: 0.49-1.16; I2 = 84.9%), ascites HR 0.85 (95% CI: 0.55-1.29; I2 = 0.0%), oesophageal variceal bleeding RR 0.88 (95% CI: 0.59-1.30; I2 = 12.8%), and hepatic encephalopathy RR 0.89 (95% CI: 0.03-23.05; I2 = 83.4%). None of the pooled estimates reached statistical significance, largely attributable to the small number of contributing studies and substantial heterogeneity driven by aetiological diversity across cohorts. These results suggest that SGLT2i may be preferable to DPP4i in patients with compensated cirrhosis requiring antidiabetic intensification, though prospective randomised trials are needed to confirm this conclusion.
Shetty et al. (Sun,) studied this question.