Effects of sodium glucose co-transporter-2 inhibitors and glucagon like peptide-1 receptor agonists in diabetic metabolic dysfunction-associated steatotic liver disease management

Table 2 Metabolic dysfunction-associated steatotic liver disease treatment with sodium-glucose co-transporter 2 inhibitor

Therapeutic strategies	Approach	Details	Clinical positioning
Monotherapy	SGLT2i alone	Effective for metabolic improvement and steatosis reduction	Best suited for MASLD with T2DM
Combination therapy	With GLP-1RA, pioglitazone	Potential synergistic metabolic and hepatic effects (PubMed)	Emerging strategy (not yet standardized)
Patient selection	T2DM + MASLD	Strongest evidence in diabetic populations	First-line metabolic-targeted option
	Non-diabetic MASLD	Less consistent benefit	Consider in selected metabolic phenotype
Treatment duration	Short-term (≤ 24 weeks)	Demonstrates measurable improvement in steatosis	Most RCTs short-term
	Long-term therapy	Needed for fibrosis/hard outcomes	Evidence still limited
Endpoints for monitoring	Imaging (CAP, MRI-PDFF), LSM	Non-invasive monitoring preferred	Surrogate markers widely used
Position in guidelines (emerging)	Adjunct therapy	Not yet MASLD-specific approved therapy	Used based on metabolic indication (T2DM, obesity)

SGLT2i: Sodium-glucose co-transporter 2 inhibitors; GLP-1RA: Glucagon-like peptide-1 receptor agonists; T2DM: Type 2 diabetes mellitus; MASLD: Metabolic dysfunction-associated steatotic liver disease; CAP: Controlled attenuation parameter; MRI-PDFF: Magnetic resonance imaging-proton density fat fraction; LSM: Liver stiffness measurement; RCTs: Randomized controlled trials.