Hepatogenous diabetes: Knowledge, evidence, and skepticism

Table 4 Factors that might influence selection of antidiabetic medication for hepatogenous diabetes

Condition	Antidiabetic drug with pros and cons	Preferences
Obesity	Metformin, SGLT2i, and GLP-1 agonists promote weight loss; DPP-4 inhibitors are weight neutral; Sulfonylureas, Pioglitazone, and Insulin promote weight gain	Should be preferred; May be considered; Consider alternative
Sarcopenia	Metformin and TZD appears to have favorable effect on muscles mass; SGLT2 inhibitors, SUs (especially glibenclamide and glinides) may increase the risk of sarcopenia	Should be preferred; Consider alternative
Hyperammonemia/Recurrent HE	Metformin and AGIs cause reduction of blood ammonia levels and risk of HE	May be preferred
Renal impairment	Insulin and linagliptin appear to be safe; SGLT-2 inhibitors may be considered with dose modification. It has added diuretic advantage; Metformin increases the risk of lactic acidosis	Should be preferred; May be considered; Should be avoided
Hypoglycemia	Insulin in SU have high risk of hypoglycaemia; Metformin, PZD, DPP4i and SGLT2 inhibitors have low risk of hypoglycaemia	Should be avoided; May be considered
LC with dysplastic liver lesion/high serum AFP	Metformin decreases the risk of HCC; DPP4 inhibitors and pioglitazone inhibit HCC development in experimental model; Insulin increases risk of HCC	Should be preferred; May be consider; Should be avoided

TZD: Thiazolidinedione; SU: Sulfonylurea; GLP-1: Glucagon-like peptide-1; DPP-4: Dipeptidyl peptidase 4; AGI: Alpha-glucosidase inhibitors; SGLT2: Sodium glucose co-transporter-2; HE: Hepatic encephalopathy; HCC: Hepatocellular carcinoma; AFP: Alfa-fetoprotein.