Abstract Body: Introduction: Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly associated with T2DM and is a common cause of chronic liver disease and cardiovascular disease (CVD). Our goal was to examine the effects of various antidiabetic agents such as Metformin, sodium-glucose transport protein-2 inhibitors (SGLT2i), glucagon-like peptide 1 receptor analogs (GLP-1RAs), compared to insulin(ins) alone, as the control, in T2DM patients with liver fibrosis (based on FIB-4 score) as major comorbidities. We also wanted to investigate how do these agents affect the lipid parameters. Methods: We conducted a cross-sectional chart review of patients with using FIB-4 score at or above 1.3 and 1.8, to detect subjects at risk for liver hepato-steatosis at the DC VAMC Diabetes Clinic for over 24 months. We screened a total of 255 patients based on the inclusion criteria. Results: Patients had a mean age of 72.64±0.67 and were mostly on ins alone (32.23%). The mean BMI was 30.43±0.58 and A1C was 7.8±0.13. Using Mann-Whitney test, Metformin (+/- insulin) group had significantly lower FIB-4 score of 1.76±0.08 (n = 24) compared to SGLT2-i (+/- insulin or metformin) with 2.29±0.2 (p=0.0370) (n=32), while GLP-1RA(+/-ins or met) had a FIB-4 score of 1.9±0.1 (n= 30). Insulin only group had the highest FIB-4 of 2.36±0.22 (n = 41).
The lipid panels were also analyzed with the mean LDL of GLP-1RA(+/-ins or met) had 70.40 ±6.065, SGLT2i(+/-ins or met) had 66.00 ±4.312, Metformin(+/-ins) had 79.79 ±8.026, and ins only had 71.95 ±6.463. The mean HDL for GLP-1RA(+/-ins or met) had 45.77±2.378, SGLT2i(+/-ins or met) had 43.31 ±2.897, Metformin(+/-ins) had 46.46±2.341, ins only had 56.20±2.695. The mean total cholesterol of GLP-1RA(+/-ins or met) was 140.2±7.653, SGLT2i(+/-ins or met) had 132.3±4.671, Metformin(+/-ins) had 146.3±8.659, ins only had 149.3±7.134. The mean triglyceride of GLP-1RA(+/-ins or met) had 134.4±10.68, SGLT2i(+/-ins or met) had 162.5±17.52, Metformin(+/-ins) 114.2±7.849, ins only had 120.8±11.99. Conclusion: In our predominantly African-American cohort, Metformin group appears to have the lowest FIB-4 score compared to other regimens with GLP1A coming at a close second. Additionally, the lipid parameters LDL, HDL, and total cholesterol seem to be similar across the medication groups except for triglyceride, where SGLT2i seems to be associated with statistically significant higher values compared to non-SGLT2i groups, particularly Metformin group.