COMPARISON OF GLYCEMIC CONTROL ACTVITY OF SGLT2 INHIBITORS AND SULPHONYLUREAS IN PATIENTS OF DECOMPENSATED LIVER DISEASE

Background: Diabetes mellitus (DM) is a well-established risk factor for worsening structural and biochemical parameters in decompensated chronic liver disease (DCLD), a condition with significant global morbidity and mortality (1,2). Poor glycemic control in DCLD increases the likelihood of complications such as hepatic encephalopathy, gastrointestinal bleeding, and ascites. Achieving optimal glycemic control is essential to slow disease progression, reduce complications, and improve survival outcomes. The selection of appropriate second-line oral antidiabetic drugs (ADDs) in this population remains a matter of clinical debate. Objective: To compare the efficacy and safety of sulphonylureas (SU) and sodium-glucose co-transporter 2 (SGLT2) inhibitors in achieving glycemic control in patients with DCLD. Methods: This longitudinal cross-sectional study was conducted at Combined Military Hospital Jhelum from May 2024 to January 2025. Using non-probability convenience sampling, 100 patients with DM and DCLD for at least one-year, inadequate glycemic control on metformin, and no major comorbidities were enrolled. Patients were assigned to either SU (n=50) or SGLT2 inhibitor (n=50) therapy. Baseline and 3-month follow-up assessments included fasting blood glucose (FBG), post-prandial glucose (PPG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine, albumin, cholesterol, body weight, and hypoglycemia incidence. Data analysis was performed using SPSS v25 with chi-square test, considering p<0.05 as statistically significant. Results: Baseline characteristics were comparable between SU and SGLT2 groups in age (59.40±9.09 vs 59.96±9.54 years), BMI (29.32±1.53 vs 28.90±2.31 kg/m²), duration of DM (9.70±3.46 vs 10.00±1.93 years), and DCLD (9.16±2.92 vs 9.66±3.10 years). At 3 months, both groups showed reductions in FBG (204.80±25.54 to 175.50±28.32 vs 214.76±26.17 to 169.70±27.88 mg/dL, p=0.305) and PPG (238.02±28.99 to 222.78±25.95 vs 246.10±29.19 to 225.04±25.12 mg/dL, p=0.659), without significant intergroup difference. Hypoglycemia was more frequent in the SU group (16% vs 4%, p=0.046). ALT, albumin, and body weight changes were non-significant between groups. Conclusion: Both SU and SGLT2 inhibitors demonstrated comparable glycemic control in DCLD, though the lower hypoglycemia incidence with SGLT2 inhibitors suggests a safety advantage in patients with prior hypoglycemia.