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. 2024 Jul 10;14(14):1475.
doi: 10.3390/diagnostics14141475.

New Insights on Using Oral Semaglutide versus Dapagliflozin in Patients with Type 2 Diabetes and Metabolic Dysfunction-Associated Steatotic Liver Disease

Ermina Stratina  1   2 , Carol Stanciu  1   2 , Robert Nastasa  1   2 , Sebastian Zenovia  1   2 , Remus Stafie  1   2 , Adrian Rotaru  1   2 , Tudor Cuciureanu  1   2 , Cristina Muzica  1   2 , Catalin Sfarti  1   2 , Irina Girleanu  1   2 , Horia Minea  1   2 , Oana Petrea  1   2 , Laura Huiban  1   2 , Stefan Chiriac  1   2 , Ana-Maria Singeap  1   2 , Oana Vlad  3 , Camelia Cojocariu  1   2 , Anca Trifan  1   2
Affiliations

New Insights on Using Oral Semaglutide versus Dapagliflozin in Patients with Type 2 Diabetes and Metabolic Dysfunction-Associated Steatotic Liver Disease

Ermina Stratina et al. Diagnostics (Basel). .

Abstract

Background and aims: Increases in both the prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity are closely related. Type 2 diabetes (T2DM) has been associated with metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis and hepatocellular carcinoma. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist approved for the treatment of T2DM and has an important role in weight loss. Also, it may represent a new therapeutic option for the treatment of MASH in obese diabetic patients. The main outcomes were changes from baseline in liver steatosis and fibrosis at week 24.

Material and methods: A total of one hundred eighty-seven patients with T2DM were eligible for this prospective study; ninety-five subjects were treated with oral semaglutide, and ninety-two patients were treated with dapagliflozin as an add-on to metformin. All the subjects were evaluated using Vibration Controlled Transient Elastography (VCTE) from June to December 2022.

Results: From our cohort, 54% of the patients were females, with a mean age of 59.92 ± 11.89 years and a mean body mass index (BMI) of 29.53 ± 5.33 kg/m2. Following a six-month medication period, we observed a substantial reduction in anthropometric measurements, including the BMI, waist circumference (WC), and waist-to-hip ratio (WtHr), in both groups. Regarding HbA1c, a notable decrease was observed in the semaglutide group (p < 0.001) when compared to the dapagliflozin group (p = 0.011). In addition, the liver stiffness measurement (LSM) according to VCTE improved significantly in the semaglutide group participants from 8.07 ± 2.90 kPa at baseline to 6.51 ± 3.09 kPa after medication (p < 0.001).

Conclusion: The superior metabolic effects of semaglutide, correlated to dapagliflozin, may contribute to a more efficient decrease in hepatic stress and injury, leading to a substantial enhancement of liver function in T2DM patients. Further investigations conducted over an ideal timeframe are necessary to confirm the evidence presented in this study.

Keywords: GLP1-analogs; MASLD; SGLT2-inhibitors; liver fibrosis; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study participant flow chart.
Figure 2
Figure 2
Prevalence of liver steatosis.
Figure 3
Figure 3
Prevalence of liver fibrosis grades.
Figure 4
Figure 4
(A,B) Correlation between CAP values and HbA1c in semaglutide and dapagliflozin group.
Figure 5
Figure 5
(A,B) LSM regression after 6 months of semaglutide vs. dapagliflozin.
Figure 6
Figure 6
(A,B) CAP regression after 6 months of semaglutide vs. dapagliflozin.
Figure 7
Figure 7
(A–D) Correlation between CAP and LSM or Agile3+ score in both groups.
Figure 8
Figure 8
(A–D) Correlation between CAP values and non-invasive biomarkers of liver fibrosis in both groups.
See this image and copyright information in PMC

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