Glucagon-like Peptide-1 Receptor Agonists Are Associated With Improved Survival and Reduced Liver-Related Events in Patients With Type 2 Diabetes and Metabolic Dysfunction-Associated Liver Disease: A Large Real-World Retrospective Study
Main finding · All-cause mortalityResult — go to the resultHazard ratio 0.59Authors' conclusion
In this large real-world cohort, GLP-1 RA use was associated with improved survival and hepatic outcomes in T2DM patients with MASLD/MASH, particularly among those without established cirrhosis. PGZ exhibited hepatic benefits. These findings highlight the potential importance of further prospective studies to evaluate early GLP-1 RA therapy in this high-risk diabetic population with MASLD/MASH.
Study context
- Population
- Adults with T2D and MASLD/MASH from 2006 onward (ICD codes); confounding liver diseases, overlapping study medications or bariatric surgery excludedbefore matching
- Participants
- 558,075 adults
- Exposure
- GLP-1 RA or pioglitazone vs other antidiabetic agents
- GLP-1 RAn = 17,465
- Pioglitazone (PGZ)n = 1,803
- Outcome
- All-cause mortality
Methodological detailsreal-world, TriNetX platform, 1:1 propensity score matching
- Real-world
- TriNetX platform
- 1:1 propensity score matching
Main finding
As reported in the abstract
Hazard ratio
0.59
P < 0.0001
Observational data: associations, not effects.
Further findings
| Outcome | HR |
|---|---|
| Liver-related outcomes (LRO)GLP-1 RA vs Controls | 0.77 |
| Liver-related outcomes (LRO)PGZ vs Controls | 0.68 |
| Liver transplantationGLP-1 RA vs Controls | 0.33 |
Cirrhotic patients: transplant and mortality
- GLP-1 RA linked to fewer transplant events but no significant mortality reduction
BMI and HbA1c
- Greater reductions in BMI and HbA1c with GLP-1 RA vs controls
Original publication
Glucagon-like Peptide-1 Receptor Agonists Are Associated With Improved Survival and Reduced Liver-Related Events in Patients With Type 2 Diabetes and Metabolic Dysfunction-Associated Liver Disease: A Large Real-World Retrospective Study. Endocr Pract. Published 28 April 2025. doi:10.
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