Table 1.
Selected Baseline Characteristics in Propensity Score Matched Cohorts of Patients with Cirrhosis and Diabetes Initiating GLP-1 Receptor Agonists or a Comparator Medication
| Cohort 1 GLP-1RA vs. DPP-4i |
Cohort 2 GLP-1RA vs. Sulfonylurea |
Cohort 3 GLP-1RA vs. SGLT2i |
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|---|---|---|---|---|---|---|
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| Baseline Characteristic | GLP-1RA N=1,431 |
DPP-4i N=1,431 |
GLP-1RA N=1,246 |
Sulfonylurea N=1,246 |
GLP-1RA N=845 |
SGLT2i N=845 |
| Male, % | 778 (54.2) | 785 (54.7) | 704 (56.5) | 693 (55.6) | 502 (52.0) | 498 (51.6) |
| Age, years - mean (SD) | 57.6 (9.1) | 57.6 (9.5) | 57.5 (9.1) | 57.6 (9.6) | 58.0 (8.7) | 58.1 (8.4) |
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| Etiology of Cirrhosis | ||||||
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| Viral Hepatitis | 111 (7.7) | 107 (7.5) | 90 (7.2) | 92 (7.4) | 78 (9.2) | 78 (9.2) |
| Alcoholic Liver Disease | 128 (8.9) | 125 (8.7) | 114 (9.2) | 127 (10.2) | 85 (10.1) | 94 (11.1) |
| Nonalcoholic fatty liver disease | 922 (64.3) | 927 (64.6) | 788 (63.2) | 773 (62.0) | 511 (60.5) | 501 (59.3) |
| Other / Unspecified | 274 (19.1) | 276 (19.2) | 255 (20.4) | 255 (20.4) | 171 (20.2) | 172 (20.4) |
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| Cirrhosis Severity | ||||||
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| Hospitalization for hepatic decompensation1 | 117 (8.2) | 115 (8.0) | 89 (7.1) | 97 (7.8) | 66 (7.8) | 63 (7.5) |
| Ascites / SBP | 68 (4.7) | 66 (4.6) | 56 (4.5) | 64 (5.1) | 42 (5.0) | 42 (5.0) |
| Hepatic encephalopathy | 58 (4.0) | 60 (4.2) | 55 (4.4) | 54 (4.3) | 37 (4.4) | 33 (3.9) |
| Esophageal varices (any) | 53 (3.7) | 46 (3.2) | 36 (2.9) | 36 (2.9) | 30 (3.6) | 27 (3.2) |
| Bleeding esophageal varices | 17 (1.2) | 14 (1.0) | 10 (0.8) | 5 (0.4) | 7 (0.8) | 6 (0.7) |
| Hepatocellular carcinoma | 36 (2.5) | 37 (2.6) | 28 (2.2) | 29 (2.3) | 24 (2.8) | 23 (2.7) |
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| Diabetes Severity | ||||||
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| Nephropathy | 42 (2.9) | 45 (3.1) | 37 (3.0) | 35 (2.8) | 22 (2.6) | 22 (2.6) |
| Neuropathy | 126 (8.8) | 128 (8.9) | 106 (8.5) | 108 (8.7) | 67 (7.9) | 70 (8.3) |
| Retinopathy | 26 (1.8) | 26 (1.8) | 21 (1.7) | 17 (1.4) | 5 (0.6) | 7 (0.8) |
| Diabetic foot | 25 (1.7) | 27 (1.9) | 17 (1.4) | 20 (1.6) | 11 (1.3) | 12 (1.4) |
| Dorsopathies | 240 (16.7) | 237 (16.5) | 195 (15.6) | 186 (14.9) | 102 (12.1) | 104 (12.3) |
| Hypoglycemia | 41 (2.9) | 34 (2.4) | 25 (2.0) | 21 (1.7) | 17 (2.0) | 16 (1.9) |
| Skin & soft tissue infections | 97 (6.8) | 91 (6.3) | 74 (5.9) | 73 (5.9) | 35 (4.1) | 40 (4.7) |
| Diabetes without complications | 978 (68.2) | 971 (67.7) | 810 (65.0) | 797 (63.9) | 408 (48.3) | 407 (48.2) |
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| Diabetes Medication Use | ||||||
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| Metformin | 724 (50.5) | 724 (50.5) | 581 (46.6) | 605 (48.5) | 449 (53.1) | 453 (53.6) |
| Glitazone | 150 (10.5) | 136 (9.5) | 114 (9.1) | 126 (10.1) | 45 (5.3) | 48 (5.7) |
| Insulin | 294 (20.5) | 300 (20.9) | 125 (10.0) | 139 (11.1) | 83 (9.8) | 77 (9.1) |
| SGLT2i | 87 (6.1) | 86 (6.0) | 81 (6.5) | 85 (6.8) | -- | -- |
| DPP-4i | -- | -- | 76 (6.1) | 70 (5.6) | 201 (23.8) | 196 (23.2) |
| Sulfonylurea | 463 (32.3) | 459 (32.0) | -- | -- | 270 (32.0) | 254 (30.1) |
| Meglinitides | 9 (0.6) | 8 (0.6) | 11 (0.9) | 11 (0.9) | 4 (0.5) | 3 (0.4) |
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| Comorbidities | ||||||
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| Alcohol abuse / dependence | 83 (5.8) | 82 (5.7) | 65 (5.2) | 59 (4.7) | 34 (4.0) | 32 (3.8) |
| Cancer (any) | 105 (7.3) | 104 (7.2) | 76 (6.1) | 78 (6.3) | 47 (5.6) | 48 (5.7) |
| Drug abuse / dependence | 10 (0.7) | 9 (0.6) | 10 (0.8) | 10 (0.8) | 5 (0.6) | 2 (0.2) |
| Obesity | 219 (15.3) | 228 (15.9) | 200 (16.0) | 203 (16.3) | 120 (14.2) | 117 (13.8) |
| Smoking (ever) | 98 (6.8) | 98 (6.8) | 75 (6.0) | 83 (6.7) | 73 (8.6) | 80 (9.5) |
| Hypertension | 617 (43.0) | 630 (43.9) | 503 (40.3) | 495 (39.7) | 292 (34.6) | 275 (32.5) |
| Dyslipidemia | 215 (15.0) | 215 (15.0) | 187 (15.0) | 180 (14.4) | 78 (9.2) | 76 (9.0) |
| Ischemic heart disease | 144 (10.0) | 149 (10.4) | 104 (8.3) | 107 (8.6) | 67 (7.9) | 60 (7.1) |
| Congestive heart failure | 78 (5.4) | 77 (5.4) | 62 (5.0) | 60 (4.8) | 29 (3.4) | 25 (3.0) |
| Cerebrovascular disease | 33 (2.3) | 20 (1.4) | 26 (2.1) | 24 (1.9) | 13 (1.5) | 11 (1.3) |
| Chronic obstructive pulmonary disease | 61 (4.3) | 66 (4.6) | 43 (3.4) | 33 (2.6) | 26 (3.1) | 23 (2.7) |
| Non-diabetes chronic kidney disease | 62 (4.3) | 65 (4.5) | 57 (4.6) | 50 (4.0) | 28 (3.3) | 23 (2.7) |
| Depression | 125 (8.7) | 133 (9.3) | 112 (9.0) | 106 (8.5) | 59 (7.0) | 55 (6.5) |
| Dementia | 14 (1.0) | 16 (1.1) | 13 (1.0) | 14 (1.1) | 4 (0.5) | 4 (0.5) |
| Osteoporosis | 52 (3.6) | 55 (3.8) | 51 (4.1) | 52 (4.2) | 21 (2.5) | 24 (2.8) |
| Falls | 24 (1.7) | 14 (1.7) | 22 (1.8) | 20 (1.6) | 26 (3.1) | 21 (2.5) |
| Fractures | 29 (2.0) | 29 (2.0) | 23 (1.8) | 18 (1.4) | 14 (1.7) | 15 (1.8) |
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| Medication Use | ||||||
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| Number of prescription drugs, mean (SD) | 11.2 (5.7) | 11.2 (5.9) | 11.2 (5.9) | 11.2 (6.2) | 12.0 (5.9) | 11.8 (5.6) |
| ACE inhibitors | 475 (33.1) | 466 (32.5) | 380 (30.5) | 405 (32.5) | 285 (33.7) | 279 (33.0) |
| Angiotensin II receptor blockers | 321 (22.4) | 345 (24.0) | 275 (22.1) | 265 (21.3) | 200 (23.7) | 195 (23.1) |
| Anticoagulants | 70 (4.9) | 80 (5.6) | 58 (4.7) | 64 (5.1) | 36 (4.3) | 34 (4.0) |
| Antiplatelets | 82 (5.7) | 75 (5.2) | 75 (6.0) | 73 (5.9) | 52 (6.2) | 54 (6.4) |
| Non-selective beta blockers | 389 (27.1) | 409 (28.5) | 334 (26.8) | 343 (27.5) | 255 (30.2) | 244 (28.9) |
| Bisphosphonates | 27 (1.9) | 27 (1.9) | 27 (2.2) | 31 (2.5) | 12 (1.4) | 11 (1.3) |
| Loop diuretics | 356 (24.8) | 356 (24.8) | 307 (24.6) | 289 (23.2) | 217 (25.7) | 208 (24.6) |
| Other diuretics | 261 (18.2) | 248 (17.3) | 229 (18.4) | 228 (18.3) | 153 (18.1) | 144 (17.0) |
| Statins | 539 (37.6) | 523 (36.4) | 464 (37.2) | 477 (38.3) | 357 (42.2) | 362 (42.8) |
| Non-statin lipid-lowering drugs | 176 (12.3) | 177 (12.3) | 166 (13.3) | 165 (13.2) | 114 (13.5) | 104 (12.3) |
| Antibiotics (any) | 755 (52.6) | 742 (51.7) | 628 (50.4) | 626 (50.2) | 447 (52.9) | 432 (51.1) |
| Antibiotics-fluoroquinolones | 276 (19.2) | 270 (18.8) | 226 (18.1) | 229 (18.4) | 154 (18.2) | 160 (18.9) |
| Anticonvulsants | 261 (18.2) | 248 (17.3) | 229 (18.4) | 228 (18.3) | 166 (19.6) | 163 (19.3) |
| Antidepressants | 514 (35.8) | 514 (35.8) | 468 (37.5) | 460 (36.9) | 311 (36.8) | 314 (37.2) |
| Benzodiazepines | 245 (17.1) | 241 (16.8) | 221 (17.7) | 209 (16.8) | 154 (18.2) | 148 (17.4) |
| Opioids | 608 (42.4) | 582 (40.6) | 519 (41.6) | 492 (39.5) | 343 (40.6) | 329 (38.9) |
| Rifaximin and/or Lactulose | 164 (11.4) | 173 (12.1) | 153 (12.3) | 151 (12.1) | 112 (13.3) | 103 (12.2) |
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| Healthcare Utilization in Prior 180 Days | ||||||
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| Any hospitalization | 300 (20.9) | 289 (20.1) | 225 (18.0) | 231 (18.5) | 155 (18.30 | 143 (16.9) |
| Any ED visit | 460 (32.1) | 474 (33.0) | 366 (29.4) | 384 (30.8) | 267 (31.6) | 249 (29.5) |
| Any abdominal ultrasound | 650 (45.3) | 639 (44.5) | 560 (44.9) | 569 (45.6) | 385 (45.6) | 393 (46.5) |
| Any paracentesis | 33 (2.3) | 32 (2.2) | 28 (2.2) | 36 (2.9) | 20 (2.4) | 18 (2.1) |
| Any upper endoscopy | 429 (29.9) | 431 (30.0) | 365 (29.3) | 355 (28.5) | 259 (30.7) | 263 (31.1) |
| Any variceal banding | 74 (5.2) | 69 (4.8) | 58 (4.7) | 65 (5.2) | 45 (5.3) | 47 (5.6) |
| Any visit to gastroenterologist | 775 (54.0) | 749 (52.2) | 691 (55.4) | 701 (56.2) | 479 (56.7) | 486 (57.5) |
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| Preventative Care in Prior 180 Days | ||||||
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| Receipt of pneumonia vaccine | 148 (10.3) | 160 (11.1) | 139 (11.1) | 147 (11.8) | 121 (4.3) | 125 (14.8) |
| Receipt of flu vaccine | 238 (16.6) | 256 (17.8) | 225 (18.0) | 235 (18.8) | 147 (17.4) | 152 (18.0) |
| Colonoscopy | 198 (13.8) | 193 (13.4) | 165 (13.2) | 160 (12.8) | 120 (14.2) | 132 (15.6) |
| Mammogram | 170 (11.8) | 169 (11.8) | 170 (13.6) | 168 (13.5) | 99 (11.7) | 103 (12.2) |
| PSA or DRE | 149 (10.4) | 161 (11.2) | 139 (11.1) | 157 (12.6) | 95 (11.2) | 99 (11.7) |
| HbA1c testing | 1,069 (74.5) | 1,075 (74.9) | 925 (74.2) | 918 (73.6) | 650 (76.9) | 654 (77.4) |
| Liver function testing | 541 (37.7) | 553 (38.5) | 466 (37.4) | 492 (39.5) | 282 (33.4) | 281 (33.3) |
Abbreviations: GLP-1RA, glucose-like peptide 1 receptor agonist; DPP-4 inhibitor, dipeptidyl peptidase-4 inhibitor; SGLT-2 inhibitor, sodium-glucose cotransporter-2 inhibitor; SD, standard deviation; SBP, spontaneous bacterial peritonitis; ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; ED, emergency department; PSA, prostate-specific antigen; DRE, digital rectal examination; HbA1c, hemoglobin A1c).
1
Hepatic decompensation events included any hospitalization for which primary cause included ascites, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, hepatic encephalopathy or bleeding esophageal varices. For details see Methods.