Annals of Hepatology · Oct 22, 2026

Sodium-glucose cotransporter-2 inhibitors and mortality and liver-related outcomes in patients with alcoholic cirrhosis, type 2 diabetes, and obesity

By Osman MM, Sims OT, Chiang DJ

INTRODUCTION AND OBJECTIVES: Sodium-glucose co-transporter 2 inhibitors (SGLT2-i¹) improve cardiovascular and renal outcomes in type 2 diabetes mellitus, but their safety and clinical impact in advanced liver disease remain uncertain because patients with cirrhosis were underrepresented in major trials. MATERIALS AND METHODS: Using the TriNetX research network, we identified adults with alcoholic cirrhosis, type 2 diabetes, and obesity and compared outcomes according to SGLT2-i exposure. After 1:1 propensity score matching, 5,128 matched pairs were analyzed. The primary outcome was all-cause mortality; secondary outcomes included all-cause hospitalization, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and variceal bleeding. RESULTS: In the matched cohort, SGLT2-i use was associated with lower all-cause mortality (HR, 0.71; 95% CI, 0.66 to 0.78), hospitalization (HR, 0.84; 95% CI, 0.80 to 0.89), ascites (HR, 0.72; 95% CI, 0.67 to 0.77), spontaneous bacterial peritonitis (HR, 0.74; 95% CI, 0.62 to 0.87), and variceal bleeding (HR, 0.82; 95% CI, 0.67 to 0.99), with no difference in hepatic encephalopathy. CONCLUSIONS: Among patients with alcoholic cirrhosis, type 2 diabetes, and obesity, SGLT2-i use was associated with improved survival and fewer liver-related complications.

doi.org/10.1016/j.aohep.2026.102470 Open access PubMed 42913941 Interventions