Association of Sodium-Glucose Cotransporter-2 Inhibitor Use with Laboratory- and Anthropometry-Derived Indices of Hepatic Steatosis and Fibrosis in Type 2 Diabetes: A Retrospective Cohort Study

Sodium-glucose cotransporter-2 inhibitors lower body weight, and their association with liver steatosis and fibrosis scores in routine practice is uncertain. We performed a retrospective cohort study of 493 adults with type 2 diabetes of at least 5 years’ duration at a tertiary hospital in Türkiye. Of these, 268 adults initiated a sodium-glucose cotransporter-2 inhibitor (dapagliflozin or empagliflozin) and used it regularly for at least 6 months, and 225 adults continued other therapies. All patients underwent liver ultrasonography. We compared 6-month changes in the hepatic steatosis index, the visceral adiposity index, the triglyceride-glucose index, the fibrosis-4 index and the aspartate aminotransferase-to-platelet ratio index. Analyses used regression with prespecified clinical covariates, inverse probability weighting and propensity score matching. The hepatic steatosis index fell more in the inhibitor group (adjusted difference: −0.69, 95% confidence interval: −1.13 to −0.25, p=0.002; weighting: −0.73; matching: −0.61). The body weight fell by 2.26 kg more (95% confidence interval: −2.70 to −1.83). The ratio of alanine to aspartate aminotransferase did not differ between groups. After adding the change in body weight to the model, the difference in the hepatic steatosis index disappeared (0.12, 95% confidence interval: -0.35 to 0.58). The fibrosis-4 index was slightly lower in the inhibitor group (adjusted difference: -0.13, 95% confidence interval: -0.19 to -0.08), whereas the other three indices did not differ clearly after adjustment. In this cohort, the lower hepatic steatosis index with these drugs reflects weight loss, and the index gives little separate information on liver fat.