Evolution of liver fibrosis in diabetic patients with NAFLD in a follow-up study: Hepatoprotective effects of sodium-glucose co-transporter-2 inhibitors

医学 内科学 胃肠病学 糖尿病 脂肪肝 纤维化 2型糖尿病 疾病 内分泌学
作者
Rosa Lombardi,Alessandro Mantovani,Annalisa Cespiati,Paolo Francione,Gabriele Maffi,Elena Del Zanna,Claudio Maffeis,Antonio Colecchia,Nicola Passigato,Alberto Ferrarese,Caterina Daniela Cusumanu,Rosanna Villani,Emanuela Orsi,Valeria Grancini,Lorena Airaghi,Daniela Bignamini,Gaetano Serviddio,Giovanni Targher,Paola Dongiovanni,Silvia Fargion,Anna Ludovica Fracanzani
出处
期刊:Digestive and Liver Disease [Elsevier]
卷期号:56 (4): 551-558 被引量:5
标识
DOI:10.1016/j.dld.2023.09.023
摘要

Abstract

Background and aims

Patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are at high risk of hepatic fibrosis. To prospectively evaluate changes in fibrosis in diabetic patients with NAFLD, predisposing factors and sodium glucose cotransporter 2 inhibitors (SGLT2i) influence.

Methods

237 T2DM outpatients (mean age 67 ± 9 years, 54% male) were enrolled and re-evaluated after 52 ± 10 months. At baseline and follow-up NAFLD and liver fibrosis (LSM) were detected by ultrasonography and Fibroscan®.

Results

During follow-up an increase in LSM (6.0 ± 2.8 vs 5.8 ± 2.7 kPa, p = 0.02) and in the prescription of SGLT2i (20% vs 6%, p<0.001) was registered, despite stability of diabetic control. LSM worsened in 133(56%) subjects, 92 (39%) with worsening >10% from baseline. Patients with worsening versus non worsening of LSM had higher prevalence of increase in BMI during follow-up (45% vs 32%, p = 0.06) and lower SGLT2i prescription (15% vs 27%, p = 0.034). In multivariate analysis use of SGLT2-inhibitors at follow-up reduced the risk of LSM worsening (HR 0.34, 95% CI 0.13–0.88), even when considered>10% from baseline.

Conclusions

A high prevalence of fibrosis progression was observed in diabetic subjects with NAFLD over a nearly 5-years follow up and SGLT2-inhibitors seem to reduce the risk of worsening of liver stiffness.
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