Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)

ABSTRACT Aim The favor effect on liver disease by odium‐glucose cotransporter inhibitor (SGLT2i) and GLP‐1 receptor agonist (GLP1Ra) was reported; however, the effect of the combination treatment of these drugs was not well known. Methods We retrospectively analyzed data for 643 patients with type 2...

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Main Authors: Daisuke Tsuriya, Kazuo Kobayashi, Kei Takeshita, Takuya Hashimoto, Moritsugu Kimura, Yoshimi Muta, Hisashi Yokomizo, Yuichi Takashi, Shunichiro Tsukamoto, Kouichi Tamura, Keizo Kanasaki, Daiji Kawanami, Masao Toyoda
Format: Article
Language:English
Published: Wiley 2025-07-01
Series:Journal of Diabetes Investigation
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Online Access:https://doi.org/10.1111/jdi.70066
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author Daisuke Tsuriya
Kazuo Kobayashi
Kei Takeshita
Takuya Hashimoto
Moritsugu Kimura
Yoshimi Muta
Hisashi Yokomizo
Yuichi Takashi
Shunichiro Tsukamoto
Kouichi Tamura
Keizo Kanasaki
Daiji Kawanami
Masao Toyoda
author_facet Daisuke Tsuriya
Kazuo Kobayashi
Kei Takeshita
Takuya Hashimoto
Moritsugu Kimura
Yoshimi Muta
Hisashi Yokomizo
Yuichi Takashi
Shunichiro Tsukamoto
Kouichi Tamura
Keizo Kanasaki
Daiji Kawanami
Masao Toyoda
author_sort Daisuke Tsuriya
collection DOAJ
description ABSTRACT Aim The favor effect on liver disease by odium‐glucose cotransporter inhibitor (SGLT2i) and GLP‐1 receptor agonist (GLP1Ra) was reported; however, the effect of the combination treatment of these drugs was not well known. Methods We retrospectively analyzed data for 643 patients with type 2 diabetes receiving SGLT2i + GLP1Ra combination treatment for at least 1 year (331 and 312 patients in the GLP1Ra‐ and SGLT2i‐preceding groups, respectively). Propensity score (PS) matching was used to compare the effects of the preceding drugs on liver function. Results The mean AST and ALT values at baseline, at the initiation of combination treatment, and at final observation were 29.8 ± 20.0 and 37.7 ± 29.5, 28.7 ± 17.3 and 35.3 ± 6.0, 26.0 ± 14.6 and 30.1 ± 21.6 IU/L, respectively, indicative of significant improvements in liver function (P < 0.001). Conversely, significant progress in the fibrosis‐4 (FIB‐4) index category was observed even after the combination treatment (P = 0.03). Subgroup analysis revealed that a significant decrease in ALT was observed only in patients with a baseline ALT ≥30 IU/L after the combination treatment (P = 0.005). Improvement of the FIB‐4 index category was observed in patients in the baseline FIB‐4 index ≥2.6 group and in the 1.3 ≤FIB‐4 index <2.6 group (46% and 19%, respectively). The matched model showed no significant differences in liver function after combination treatment between the SGLT2i‐ and GLP1Ra‐preceding groups. Conclusions SGLT2i + GLP1Ra combination treatment significantly improved liver dysfunction and prevented the progression of FIB‐4 index category among patients with an FIB‐4 index ≥1.3.
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spelling doaj-art-0cf2f26ebbc742f68815ee080d2a940f2025-08-20T02:38:42ZengWileyJournal of Diabetes Investigation2040-11162040-11242025-07-011671243125310.1111/jdi.70066Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)Daisuke Tsuriya0Kazuo Kobayashi1Kei Takeshita2Takuya Hashimoto3Moritsugu Kimura4Yoshimi Muta5Hisashi Yokomizo6Yuichi Takashi7Shunichiro Tsukamoto8Kouichi Tamura9Keizo Kanasaki10Daiji Kawanami11Masao Toyoda12Division of Endocrinology and Metabolism, 2nd Department of Internal Medicine Hamamatsu University School of Medicine Hamamatsu JapanDepartment of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama JapanDivision of Endocrinology and Metabolism, 2nd Department of Internal Medicine Hamamatsu University School of Medicine Hamamatsu JapanDivision of Endocrinology and Metabolism, 2nd Department of Internal Medicine Hamamatsu University School of Medicine Hamamatsu JapanDivision of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine Tokai University School of Medicine Isehara JapanDepartment of Endocrinology and Diabetes Fukuoka University School of Medicine Fukuoka JapanDepartment of Endocrinology and Diabetes Fukuoka University School of Medicine Fukuoka JapanDepartment of Endocrinology and Diabetes Fukuoka University School of Medicine Fukuoka JapanDepartment of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama JapanDepartment of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama JapanDepartment of Internal Medicine 1, Endocrinology and Metabolism, Shimane University Faculty of Medicine, The Center for Integrated Kidney Research and Advance, Faculty of Medicine Shimane University Izumo JapanDepartment of Endocrinology and Diabetes Fukuoka University School of Medicine Fukuoka JapanDivision of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine Tokai University School of Medicine Isehara JapanABSTRACT Aim The favor effect on liver disease by odium‐glucose cotransporter inhibitor (SGLT2i) and GLP‐1 receptor agonist (GLP1Ra) was reported; however, the effect of the combination treatment of these drugs was not well known. Methods We retrospectively analyzed data for 643 patients with type 2 diabetes receiving SGLT2i + GLP1Ra combination treatment for at least 1 year (331 and 312 patients in the GLP1Ra‐ and SGLT2i‐preceding groups, respectively). Propensity score (PS) matching was used to compare the effects of the preceding drugs on liver function. Results The mean AST and ALT values at baseline, at the initiation of combination treatment, and at final observation were 29.8 ± 20.0 and 37.7 ± 29.5, 28.7 ± 17.3 and 35.3 ± 6.0, 26.0 ± 14.6 and 30.1 ± 21.6 IU/L, respectively, indicative of significant improvements in liver function (P < 0.001). Conversely, significant progress in the fibrosis‐4 (FIB‐4) index category was observed even after the combination treatment (P = 0.03). Subgroup analysis revealed that a significant decrease in ALT was observed only in patients with a baseline ALT ≥30 IU/L after the combination treatment (P = 0.005). Improvement of the FIB‐4 index category was observed in patients in the baseline FIB‐4 index ≥2.6 group and in the 1.3 ≤FIB‐4 index <2.6 group (46% and 19%, respectively). The matched model showed no significant differences in liver function after combination treatment between the SGLT2i‐ and GLP1Ra‐preceding groups. Conclusions SGLT2i + GLP1Ra combination treatment significantly improved liver dysfunction and prevented the progression of FIB‐4 index category among patients with an FIB‐4 index ≥1.3.https://doi.org/10.1111/jdi.70066FIB‐4 indexGLP‐1 receptor agonistSodium‐glucose cotransporter inhibitor
spellingShingle Daisuke Tsuriya
Kazuo Kobayashi
Kei Takeshita
Takuya Hashimoto
Moritsugu Kimura
Yoshimi Muta
Hisashi Yokomizo
Yuichi Takashi
Shunichiro Tsukamoto
Kouichi Tamura
Keizo Kanasaki
Daiji Kawanami
Masao Toyoda
Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)
Journal of Diabetes Investigation
FIB‐4 index
GLP‐1 receptor agonist
Sodium‐glucose cotransporter inhibitor
title Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)
title_full Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)
title_fullStr Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)
title_full_unstemmed Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)
title_short Liver function effects of SGLT2 inhibitor and GLP‐1 receptor agonist combination treatment in patients with type 2 diabetes (post hoc analysis of RECAP study)
title_sort liver function effects of sglt2 inhibitor and glp 1 receptor agonist combination treatment in patients with type 2 diabetes post hoc analysis of recap study
topic FIB‐4 index
GLP‐1 receptor agonist
Sodium‐glucose cotransporter inhibitor
url https://doi.org/10.1111/jdi.70066
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