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Diabetes and Vascular Disease

SAT-626 - Efficacy of SGLT2 Inhibitors in Reducing Hepatic Fibrosis in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT


Introduction: Type 2 Diabetes Mellitus (T2DM) is strongly associated with the development of liver disease and its progression to more advanced complications, such as hepatic fibrosis. Hepatic fibrosis is characterized by the accumulation of scar tissue resulting from chronic inflammation and, when identified early, may be reversible. Despite its strong association with increased liver-related morbidity and mortality, pharmacological treatment options remain limited. In this context, sodium-glucose cotransporter-2 inhibitors (SGLT2i), widely used in the management of T2DM, have demonstrated relevant metabolic and hepatic benefits. Given this scenario, a systematic evaluation of the available evidence regarding the effectiveness of SGLT2 inhibitors in reducing hepatic fibrosis in patients with T2DM is necessary.

Objective: To evaluate the efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing hepatic fibrosis in patients with Type 2 Diabetes Mellitus.

Methods: This systematic review and meta-analysis followed PRISMA guidelines. PubMed, LILACS, and Cochrane Library were searched for studies published in the last five years evaluating the effect of SGLT2 inhibitors on hepatic fibrosis in patients with T2DM. Randomized clinical trials and prospective observational studies were included. After screening 285 studies, 9 were selected for the final analysis.

Results: The included studies mainly evaluated empagliflozin, dapagliflozin, and ipragliflozin in patients with T2DM and MASLD/NAFLD/NASH. Qualitative analysis showed a consistent positive effect of SGLT2 inhibitors on hepatic fibrosis reduction. Ipragliflozin significantly improved fibrosis and hepatocyte ballooning on liver biopsy (p=0.01 and p=0.02). Noninvasive methods such as VCTE confirmed this trend, with empagliflozin and dapagliflozin reducing liver stiffness more effectively than placebo, pioglitazone, and sitagliptin. Biomarkers such as FIB-4 and NFS showed heterogeneous results, likely influenced by treatment duration. Improvements in fibrosis were associated with reduced steatosis, liver enzymes (ALT, AST), intrahepatic fat, and GGT, suggesting lower hepatic inflammation. Benefits were greater in patients with more severe baseline disease and were independent of HbA1c reduction.

Conclusion: SGLT2 inhibitors are associated with improved liver health in patients with T2DM and MASLD by improving metabolic profile, reducing inflammation, and attenuating fibrosis. Dapagliflozin, empagliflozin, and ipragliflozin showed the most consistent benefits. However, variability in FIB-4 and NFS results highlights the need for larger multicenter studies to confirm long-term efficacy and support broader clinical use.

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