Antidiabetes medication initiation trends in US adults with cirrhosis and type 2 diabetes: A nationwide study

Cirrhosis is responsible for over 40 000 deaths each year in the United States, and nearly 1.3 million deaths, worldwide, 1 with a rapidly increasing prevalence.Type 2 diabetes (T2D) disproportionately affects over 33% of patients with cirrhosis and leads to substantial morbidity and mortality, 2 including cardiovascular disease (CVD), liver decompensation and death.Current guidelines recommend initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide 1 receptor agonists (GLP-1RA) 3 in patients with T2D and CVD, cardiovascular risk factors, heart failure or chronic kidney disease, based on findings from randomized controlled trials.However, patients with cirrhosis were excluded from those trials, and thus the optimal antidiabetic medication strategy in cirrhosis is unclear.Moreover, it is unknown to what extent patients with cirrhosis are using specific glucose-lowering medications (GLM) in clinical practice.Characterizing utilization patterns of GLM in patients with cirrhosis could help identify important variations in care and barriers to uptake, and guide future research regarding the effectiveness and safety of these medications, which is needed.We sought to evaluate current prescribing patterns of GLM in patients with cirrhosis and T2D, using a nationwide health care database.