COMPARATIVE EFFECTS OF SGLT2 INHIBITORS VERSUS METFORMIN ON LIVER ENZYMES, GLYCEMIC CONTROL, AND BLOOD PRESSURE IN TYPE 2 DIABETES WITH MASLD

Abstract

Background: Comparative evidence on empagliflozin versus metformin in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) is limited in South Asian populations. This study compared their short-term effects on liver enzymes, glycemic control, and blood pressure. Methods: This twelve-week randomized comparative study was conducted in Islamabad, Pakistan. Of 210 patients screened, 170 were randomized equally to empagliflozin 10 mg once daily or metformin 1000 mg/day; 126 participants completed follow-up and were included in the per-protocol analysis. MASLD was confirmed by baseline ultrasonography. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), and adverse effects were assessed at baseline and week twelve. Adjusted between-group comparisons were performed using analysis of covariance. Results: Both groups improved significantly in ALT, AST, HbA1c, SBP, and DBP at twelve weeks. Adjusted mean differences favored empagliflozin for ALT (−6.02 U/L; 95% CI −7.62 to −4.41), AST (−2.84 U/L; 95% CI −3.67 to −2.01), HbA1c (−0.19%; 95% CI −0.24 to −0.15), SBP (−1.80 mmHg; 95% CI −3.32 to −0.28), and DBP (−1.99 mmHg; 95% CI −3.07 to −0.91). Overall adverse-effect frequency did not differ significantly between groups. Conclusion: Empagliflozin was associated with greater short-term improvement in hepatic biochemical markers, glycemic control, and blood pressure than metformin in patients with T2DM and baseline ultrasound-confirmed MASLD.