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Background: The presence of nonalcoholic fatty liver diseases (NAFLDs) and type 2 diabetes was associated with elevated risks of cardiovascular events as well as the progression of NAFLD to fibrosis/cirrhosis and hepatocellular carcinoma. Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a widely used antidiabetic drug, which promotes urinary excretion of glucose. Recent animal and human studies demonstrated the beneficial effects of SGLT2is on lipid accumulation and fibrosis in the liver. The purpose of the current study was to elucidate the effects of SGLT2is on hepatic fibrosis in the realworld setting. Methods: We selected patients with type 2 diabetes who had been prescribed SGLT2is continuously for 12 months between April 1, 2014 and March 31, 2018 by a chart-based analysis. We compared the data before the SGLT2is treatment with the data at 6 and 12 months after the SGLT2is treatment started. Fibrosis in the liver was evaluated by fibrosis-4 (FIB4) index. Results: We enrolled 315 patients in this study. The body weight, body mass index (BMI), serum levels of aspartate aminotransferase, alanine aminotransferase and γ-glutamyl transferase were significantly decreased at 6 months and maintained at 12 months, whereas there was no significant change in FIB4 index. We divided the studied patients into three groups according to the baseline FIB4 index. Only in the group of high value of the baseline FIB4 index, FIB4 index was significantly decreased at 12 months. The correlations between the change of FIB4 index during 12-month SGLT2i treatment was correlated inversely with the baseline FIB4 index. Conclusion: Present study demonstrated that SGLT2i could ameliorate fibrosis in the liver in high-risk patients for hepatic fibrosis.

Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Hepatic Fibrosis in Patients With Type 2 Diabetes: A Chart-Based Analysis