Role of sodium-glucose cotransporter 2 inhibitors in liver diseases

Sodium-glucose cotransporter 2 (SGLT2) inhibitors compete with the SGLT2 protein for glucose binding in the renal tubules, reducing glucose reabsorption in the kidneys. This in turn leads to increased excretion of glucose, sodium, and water into the urine. These inhibitors, initially developed for diabetes management, have shown potential benefits beyond glycemic control, impacting liver health through various mechanisms. They have emerged as promising agents in managing liver conditions, including fatty liver disease, cirrhosis, and the prevention of hepatocellular carcinoma (HCC). They modulate processes like oxidative stress, inflammation, and autophagy, which are implicated in metabolic dysfunction-associated steatotic liver disease pathogenesis, potentially reducing steatosis and inflammation and preventing progression to more severe liver conditions. In patients with liver cirrhosis, SGLT2 inhibitors have been associated with a reduced need for large-volume paracentesis and lower mortality rates, indicating their potential in managing diuretic-resistant ascites. SGLT2 inhibitors have shown potential in modulating molecular pathways involved in HCC, such as inflammatory responses and oxidative stress, that could justify their use in the prevention of HCC and improving survival in patients with HCC. The present review synthesized findings from multiple studies to elucidate the role of SGLT2 inhibitors in these liver conditions.