Published online Dec 20, 2024. doi: 10.5493/wjem.v14.i4.95272
Revised: August 18, 2024
Accepted: August 28, 2024
Published online: December 20, 2024
Processing time: 203 Days and 7.9 Hours
The use of dapagliflozin in patients with cirrhosis has been relatively restricted due to concerns regarding its overall safety and pharmacological profile in this population.
To determine the safety and effectiveness of dapagliflozin in the co-management of diabetes mellitus and cirrhosis with or without ascites.
The patients studied were divided into two groups: 100 patients in the control group received insulin, while 200 patients received dapagliflozin. These patients were classified as Child A, B, or C based on the Child–Pugh classification. Child A or B and Child C were administered doses of 10 mg and 5 mg of dapagliflozin, respectively.
The rate of increased diuretics dose was markedly elevated in the group that received insulin compared to the group that received dapagliflozin. In addition, dapagliflozin treatment substantially reduced weight, body mass index, and fasting blood glucose compared to the insulin group during follow-up. However, there were no significant differences in hemoglobin A1c, liver function, or laboratory investigations between both groups during the follow-up period. The incidence of hypoglycemia, hepatic encephalopathy, variceal bleeding, and urinary tract infection was significantly higher in the insulin group compared to the dapagliflozin group. In contrast, the dapagliflozin group experienced significantly higher rates of frequent urination and dizziness. In addition, the insulin group exhibited a marked worsening of ascites compared to the dapagliflozin group.
Dapagliflozin demonstrated safety and efficacy in the treatment of diabetic patients who have cirrhosis with or without ascites. This resulted in an improvement of ascites, as well as a decrease in diuretic dose and Child–Pugh score.
Core Tip: To assess the effectiveness and safety of dapagliflozin in the co-management diabetes mellitus and cirrhosis with or without ascites, patients were categorized into a control group of 100 patients administered insulin and 200 patients administered dapagliflozin. On follow-up, there was a significantly higher incidence of hypoglycemia, hepatic encephalopathy, variceal bleeding, and urinary tract infection in the insulin group than in the dapagliflozin group. Frequent micturition and vertigo were significantly higher in the dapagliflozin group. Dapagliflozin demonstrated safety and efficacy in the treatment of diabetic patients with cirrhosis, leading to improvement of ascites, decrease in diuretic dose, and Child–Pugh score.