EFFICACY OF SGLT2 INHIBITORS IN THE REDUCTION OF ASCITES IN CHRONIC LIVER FAILURE AMONG DIABETICS

Abstract

Background: Chronic liver failure with ascites represents a major clinical challenge, particularly in patients with coexisting type 2 diabetes mellitus, where conventional diuretic therapy often yields suboptimal outcomes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated diuretic, natriuretic, and metabolic benefits, suggesting potential utility in ascites management.

Aim: To evaluate the efficacy and safety of empagliflozin in reducing ascites among diabetic patients with chronic liver failure.

Methods: This randomized controlled study was conducted at Aziz Bhatti Shaheed Teaching Hospital, Gujrat, from November 2025 to April 2026, including 63 patients with cirrhosis, ascites, and type 2 diabetes mellitus. Participants were allocated into two groups: Group A (n=31) received standard therapy with spironolactone and furosemide, while Group B (n=32) received empagliflozin 10 mg daily in addition to standard therapy for 30 days. Outcomes included weight reduction, abdominal girth reduction, ascites resolution, laboratory parameters, and adverse effects. Statistical analysis was performed using SPSS version 23.0, with p≤0.05 considered significant.

Results: The empagliflozin group demonstrated significantly greater weight reduction (6.4 ± 1.8 kg vs 2.8 ± 1.2 kg; p=0.001) and abdominal girth reduction (8.5 ± 2.1 cm vs 3.5 ± 1.4 cm; p=0.001). Ascites resolution was achieved in 65.6% of patients in Group B compared to 29.0% in Group A (p=0.004). Significant improvements were also observed in serum albumin (3.2 ± 0.5 vs 2.8 ± 0.4 g/dL; p=0.01), sodium levels (135.8 ± 3.9 vs 132.5 ± 4.2 mEq/L; p=0.01), and Child-Pugh scores (7.6 ± 1.3 vs 8.9 ± 1.5; p=0.001). Adverse effects such as hypokalemia (6.3% vs 19.4%; p=0.03) and acute kidney injury (3.1% vs 12.9%; p=0.03) were significantly lower in the empagliflozin group, although urinary tract infections were slightly higher (15.6% vs 9.7%; p=0.04).

Conclusion: Empagliflozin significantly improves ascites-related outcomes and demonstrates a favorable safety profile in diabetic patients with chronic liver failure, supporting its role as an effective adjunct to standard therapy