{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:27:36Z","timestamp":1789637256170,"version":"4.0.0"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T00:00:00Z","timestamp":1745712000000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>The management of metabolic dysfunction\u2010associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) presents a significant clinical challenge, with a focus on preventing progression to liver and renal complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the liver and renal outcomes among new users of sodium\u2010glucose cotransporter 2 inhibitors (SGLT2i) versus glucagon\u2010like peptide\u20101 receptor agonists (GLP\u20101RA), dipeptidyl peptidase\u20104 inhibitors (DPP4i) and other anti\u2010diabetic medications in patients with MASLD and T2DM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Electronic health records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total number of 88\u2009306 patients with MASLD and T2DM were included in a propensity score\u2010matched analysis comparing the effects of anti\u2010diabetic drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Patients were categorized into groups based on their initiation of anti\u2010diabetic medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The primary outcomes were the incidence of cirrhosis, hepatic decompensations, and hepatocellular carcinoma. Secondary outcomes were a progression of chronic kidney disease (CKD), severity of CKD stages, and the need for hemodialysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the SGLT2i versus DPP4i, a reduced risk of cirrhosis was observed in the SGLT2i (HR: 0.97), along with fewer hepatic decompensations (HR: 0.84) and a lower incidence of HCC (HR: 0.50). CKD progression, particularly to stages 4\u20135, was significantly lower in the SGLT2i (HR: 0.53), as was hemodialysis (HR: 0.38). However, SGLT2i exhibited a slightly lower risk of CKD progression (HR: 0.77) and a reduced need for hemodialysis (HR: 0.71) compared to the GLP\u20101RA, while there was no difference in hepatic outcomes between the GLP\u20101RA and SGLT2i.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SGLT2 inhibitors in patients with MASLD and T2DM demonstrated reduced risks of liver complications and a favorable impact on renal outcomes. These findings support the preferential consideration of SGLT2i in managing this patient population, particularly for mitigating the progression of liver and kidney diseases.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1753-0407.70069","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T02:54:11Z","timestamp":1745808851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Adverse Liver and Renal Outcomes After Initiating <scp>SGLT<\/scp>\u20102i and <scp>GLP<\/scp>\u2010<scp>1RA<\/scp> Therapy Among Patients With Diabetes and <scp>MASLD<\/scp>"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9452-7377","authenticated-orcid":false,"given":"Arunkumar","family":"Krishnan","sequence":"first","affiliation":[{"name":"Department of Medicine Wake Forest University School of Medicine  Winston Salem North Carolina USA"},{"name":"Department of Supportive 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Excellence King Faisal Specialist Hospital and Research Center  Riyadh Saudi Arabia"},{"name":"Division of Gastroenterology and Hepatology Weill Cornell Medicine  New York New York 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