Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk

Utku Erdem Soyaltin; Nurana Aliyeva; Cem Balta; Tuğba Çelebi; Ilgın Yıldırım Şimşir

doi:10.19161/etd.1885126

EN TR

Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk

Abstract

Aim: Patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction–associated steatotic liver disease (MASLD) with moderate-to-advanced fibrosis risk have limited therapeutic options. We evaluated the effects of sodium–glucose cotransporter 2 inhibitors (SGLT2i) compared with other antidiabetic agents on liver stiffness in this high-risk population. Material and Methods: This retrospective study included 37 patients with T2DM and MASLD with baseline liver stiffness ≥8 kPa assessed by vibration-controlled transient elastography. Twenty-one patients received empagliflozin and 16 received other antidiabetic agents (DPP-4 inhibitors, sulfonylureas, or insulin). Liver stiffness (primary endpoint), HbA1c, body mass index (BMI), and FIB-4 were evaluated at baseline and after 24 weeks. Results: Liver stiffness decreased significantly in both groups (SGLT2i: 11.16→7.47 kPa, p<0.001; control: 11.05→8.56 kPa, p=0.004), with no significant between-group difference. FIB-4 declined in both groups, with a greater reduction observed in the SGLT2i group (p=0.005). Liver stiffness improvement correlated with HbA1c reduction in controls (r=0.341, p=0.039) but occurred independently of glycemic and weight changes in the SGLT2i group. Conclusions: In this retrospective cohort with baseline LS ≥8 kPa, LS improved over 24 weeks in both treatment groups without a significant between-group difference. The association between LS change and glycemic improvement was observed in controls but not in empagliflozin-treated patients, supporting a hypothesis-generating difference in correlates of LS change between treatment strategies.

Keywords

SGLT2 inhibitörlerinin MASLD ve orta-ileri düzeyde fibrozis riski olan tip 2 diyabetli hastalarda karaciğer sertliği üzerindeki etkileri

Abstract

Amaç: Tip 2 diyabetes mellitus (T2DM) ve metabolik disfonksiyonla ilişkili steatotik karaciğer hastalığı (MASLD) bulunan, orta-ileri fibrozis riski taşıyan hastalarda tedavi seçenekleri sınırlıdır. Bu çalışmada, orta-ileri fibrozis riski taşıyan yüksek riskli T2DM ve MASLD popülasyonunda SGLT2 inhibitörlerinin (SGLT2i) karaciğer sertliği üzerindeki etkileri diğer antidiyabetik ajanlarla karşılaştırıldı. Gereç ve Yöntem: Bu retrospektif çalışmaya, titreşim kontrollü geçici elastografi (VCTE) ile ölçülen başlangıç karaciğer sertliği ≥8 kPa olan T2DM ve MASLD tanılı 37 hasta dâhil edildi. Yirmi bir hasta empagliflozin, 16 hasta ise diğer antidiyabetik ajanları (DPP-4 inhibitörleri, sülfonilüre veya insülin) kullandı. Birincil sonlanım noktası karaciğer sertliği olup vücut kitle indeksi (VKİ), HbA1c ve FIB-4 değerleri başlangıçta ve 24. haftada değerlendirildi. Bulgular: Karaciğer sertliği her iki grupta anlamlı olarak azaldı (SGLT2i: 11.16→7.47 kPa, p<0.001; kontrol: 11.05→8.56 kPa, p=0.004) ve gruplar arasında azalma miktarı açısından anlamlı fark saptanmadı. FIB-4 her iki grupta azaldı; azalma SGLT2i grubunda daha belirgindi (p=0.005). Kontrol grubunda karaciğer sertliği değişimi HbA1c değişimi ile ilişkiliydi (r=0.341, p=0.039), SGLT2i grubunda ise bu ilişki gözlenmedi. Sonuç: Başlangıç karaciğer sertliği ≥8 kPa olan bu retrospektif kohortta, 24 haftada her iki tedavi stratejisiyle karaciğer sertliğinde anlamlı azalma izlendi ve gruplar arasında anlamlı fark saptanmadı. Glisemik iyileşme ile karaciğer sertliği değişimi arasındaki ilişkinin yalnızca kontrol grubunda görülmesi, tedavi grupları arasında karaciğer sertliği değişiminin klinik belirleyicilerinin farklı olabileceğine işaret eden hipotez oluşturucu bir bulgudur.

Keywords

Supporting Institution

none

Ethical Statement

This study was approved by the Institutional Review Board (IRB) of the Ege University Medical School Hospital (20-7.1T/7) in accordance with the Declaration of Helsinki.

Thanks

none

References

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Details

Primary Language

English

Subjects

Endocrinology

Journal Section

Research Article

Authors

Utku Erdem Soyaltin ^*
0000-0003-0229-3452
Türkiye

Nurana Aliyeva
0000-0002-8448-0552
Türkiye

Cem Balta
0000-0002-7474-0429
Türkiye

Tuğba Çelebi
0000-0001-7956-114X
Türkiye

Ilgın Yıldırım Şimşir
0000-0002-6801-8499
Türkiye

Publication Date

June 10, 2026

Submission Date

February 9, 2026

Acceptance Date

February 24, 2026

Published in Issue

Year 2026 Volume: 65 Number: 2

DOI

https://doi.org/10.19161/etd.1885126

IZ

https://izlik.org/JA68XF69BK

Cite

RIS / Bibtex

APA

Soyaltin, U. E., Aliyeva, N., Balta, C., Çelebi, T., & Yıldırım Şimşir, I. (2026). Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk. Ege Tıp Dergisi, 65(2), 295-304. https://doi.org/10.19161/etd.1885126

AMA

1.Soyaltin UE, Aliyeva N, Balta C, Çelebi T, Yıldırım Şimşir I. Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk. EJM. 2026;65(2):295-304. doi:10.19161/etd.1885126

Chicago

Soyaltin, Utku Erdem, Nurana Aliyeva, Cem Balta, Tuğba Çelebi, and Ilgın Yıldırım Şimşir. 2026. “Effects of SGLT2 Inhibitors on Liver Stiffness in Type 2 Diabetes Patients With MASLD and Moderate-to-Advanced Fibrosis Risk”. Ege Tıp Dergisi 65 (2): 295-304. https://doi.org/10.19161/etd.1885126.

EndNote

Soyaltin UE, Aliyeva N, Balta C, Çelebi T, Yıldırım Şimşir I (June 1, 2026) Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk. Ege Tıp Dergisi 65 2 295–304.

IEEE

[1]U. E. Soyaltin, N. Aliyeva, C. Balta, T. Çelebi, and I. Yıldırım Şimşir, “Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk”, EJM, vol. 65, no. 2, pp. 295–304, June 2026, doi: 10.19161/etd.1885126.

ISNAD

Soyaltin, Utku Erdem - Aliyeva, Nurana - Balta, Cem - Çelebi, Tuğba - Yıldırım Şimşir, Ilgın. “Effects of SGLT2 Inhibitors on Liver Stiffness in Type 2 Diabetes Patients With MASLD and Moderate-to-Advanced Fibrosis Risk”. Ege Tıp Dergisi 65/2 (June 1, 2026): 295-304. https://doi.org/10.19161/etd.1885126.

JAMA

1.Soyaltin UE, Aliyeva N, Balta C, Çelebi T, Yıldırım Şimşir I. Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk. EJM. 2026;65:295–304.

MLA

Soyaltin, Utku Erdem, et al. “Effects of SGLT2 Inhibitors on Liver Stiffness in Type 2 Diabetes Patients With MASLD and Moderate-to-Advanced Fibrosis Risk”. Ege Tıp Dergisi, vol. 65, no. 2, June 2026, pp. 295-04, doi:10.19161/etd.1885126.

Vancouver

1.Utku Erdem Soyaltin, Nurana Aliyeva, Cem Balta, Tuğba Çelebi, Ilgın Yıldırım Şimşir. Effects of SGLT2 inhibitors on liver stiffness in type 2 diabetes patients with MASLD and moderate-to-advanced fibrosis risk. EJM. 2026 Jun. 1;65(2):295-304. doi:10.19161/etd.1885126