Vnitr Lek 2025, 71(8):E7-E13

Potential of Glucagon-like peptide-1 receptor agonists (GLP1a) and Sodium-Glucose Co-transporter-2 inhibitors (SGLT2i) in the treatment of MASLD

Anna Török Zapletalová^{1, 3}, Boris Focko^{3, 4}, Martin Jozef Péč^{3, 4}, Daniel Ján Havaj², Ľubomír Skladaný², Emil Martinka¹, Peter Galajda^{1, 4}

¹ Diabetologické oddelenie, Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa, Slovensko

² HEGITO (Oddelenie hepatológie, gastroenterológie a transplantácie pečene) Kliniky vnútorného lekárstva II, Lekárskej fakulty Slovenskej zdravotníckej univerzity a Fakultnej nemocnice F. D. Roosevelta, Banská Bystrica, Slovensko

³ Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Slovensko

⁴ I. interná klinika, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Martin, Slovensko

Objectives: In type 2 diabetics, MASLD has a prevalence of 65.33%. DM2 itself is a risk factor for disease progression. GLP-1 receptor agonists (GLP1a) and SGLT2 inhibitors (SGLT2i) have shown significant cardioprotective and hypoglycemic effects. Their potential in the treatment of MASLD is currently being investigated. The aim of our pilot prospective observational study was to determine the prevalence of MASLD in a sample of hospitalized patients with DM2 and to evaluate the impact of GLP1a and SGLT2i on hepatic steatosis and fibrosis. Material and method: 112 hospitalized patients with DM2 and MASLD were included in the study. The presence of steatosis and fibrosis was determined using non-invasive scores and 2D-SWE. Of these, 53 patients were initiated on GLP1a (n=36) or SGLT2i (n=17) therapy and subsequently had parameters of steatosis (ATT), fibrosis (E-median), inflammatory markers (IL-6, CRP) and liver function (AST, ALT) assessed. Measurements were performed at baseline and after 6 months of treatment.

Results: Hepatic steatosis was present in 79% of patients, significant and advanced fibrosis in 26%. Patients treated with GLP1a had a statistically significant decrease in E-median (by 11.7%; P = < 0,05), ATT (by 8%; P = < 0.05), independently of BMI. Subsequently, there was a significant decrease in IL-6 (by 14.2%; P = < 0,05) and AST (by 14.4%; P = < 0.05). A non-significant downward trend was recorded in the case of ALT. In patients treated with SGLT2i, the indicators decreased, but only the AST parameter (by 14.71%; P = < 0,05) was statistically significant. A weak statistically significant correlation was demonstrated between the change in triacylglycerides and the change in the E parameter.

Conclusion: GLP1a significantly improves the parameters of steatosis, fibrosis and inflammation independently of BMI. In the case of SGLT2i, a non-significant decreasing trend of the parameters was demonstrated, probably due to the small sample size. The triacylglycerides level significantly correlates with the risk of developing and progressing MASLD. The results suggest that GLP-1 agonists and SGLT2 inhibitors may represent an effective therapeutic strategy in patients with MASLD.

Keywords: fibrosis, GLP1a, MASLD, SGLT2i, steatosis, triacylglycerides.

Accepted: November 26, 2025; Published: December 15, 2025  Show citation