Key result
SGLT2 inhibitors outperform GLP-1 RAs on liver enzymes but trail in weight and glycemic control.
Why the study?
Do SGLT2 inhibitors compared to GLP-1 receptor agonists improve hepatic and metabolic outcomes in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease?
Meta-Analysis
Do SGLT2 inhibitors compared to GLP-1 receptor agonists improve hepatic and metabolic outcomes in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease?
Answers are grounded in this paper and cite their sources.
In patients with T2DM and NAFLD, SGLT2 inhibitors are more effective for reducing liver enzymes, whereas GLP-1 receptor agonists are superior for weight loss and glycemic control.
Purpose of Review Our meta-analysis aimed to compare the efficacy of GLP-1RAs and SGLT2is in improving hepatic and metabolic outcomes in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease. We sought to determine which drug class offers superior benefits in liver enzyme reduction, glycemic control, and lipid metabolism. Recent Findings Recent meta-analyses and observational studies support substantial cardiorenal, metabolic, and hepatic benefits from GLP-1RAs and SGLT2is in T2DM patients. Large trials show that angiocrine and neuroprotective mechanisms may contribute to benefits beyond glycemic control. Combination therapy with GLP-1RA + SGLT2i is associated with additive reductions in major adverse cardiovascular events, heart failure hospitalization, and serious renal events compared to monotherapy. Cardiometabolic data from US cohorts suggest lower risks of myocardial infarction and stroke when a newer-generation GLP-1RA is added to SGLT2i therapy. Subgroup meta-analyses confirm cardiovascular risk reduction regardless of baseline metformin use. Distinct patterns emerge: GLP-1RAs are particularly effective for stroke prevention, weight loss, and glycemic control, while SGLT2is excel in preventing heart failure, cardiovascular mortality, and renal progression . Summary Both GLP-1 and SGLT2 showed benefits in patients with NAFLD and T2DM. SGLT2 showed greater effects on liver enzymes, while GLP-1 showed improved weight loss and glycemic control. Still, the choice of treatment should be based on the patient’s goals and the main clinical needs.
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Elnaggar et al. (2026) conducted a meta-analysis in Type 2 diabetes mellitus and non-alcoholic fatty liver disease. SGLT2 inhibitors vs. GLP-1 Receptor Agonists was evaluated on Hepatic and metabolic outcomes (liver enzyme reduction, glycemic control, and lipid metabolism). SGLT2 inhibitors showed greater effects on liver enzymes, while GLP-1 receptor agonists showed improved weight loss and glycemic control in patients with NAFLD and T2DM.
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