Background: Depression and mental health issues are often co-morbidities and present with management challenges. Several veterans also have MASLD which is highly associated with T2DM and is a common cause of chronic liver disease and cardiovascular disease (CVD). No pharmacological agent has been approved for the treatment of MASLD, but novel T2DM drugs appear to demonstrate some benefit. We decided to examine the effects of various antidiabetic such as Metformin, sodium-glucose transport protein-2 inhibitors (SGLT2i), glucagon-like peptide 1 receptor analogs (GLP-1RAs), as three groups of interest, compared to insulin(ins) alone, as the control, in T2DM patients with depression and liver fibrosis (based on FIB-4 score).
Methods: We conducted a retrospective chart review of patients from the Diabetes Clinic at VA Med Ctr over 10 months using (PHQ-9 score >5 for depression assessment FIB4 score > 1.3 to detect subjects at risk for liver fibrosis.
Results: Patient cohorts range from 53 to 87 years old with a 76% majority in the African American veteran population. All patients were either overweight or had obesity (BMI 25-45). The mean BMI was 32.29±0.80, which was similar across the groups with the SGLT2i (+/- ins) group having a slightly lower BMI of 27.80±1.28. Mean A1C was 8.0±0.2 with no difference found between groups. Our results were as follows: GLP-1 RA (+/- ins) had PHQ-9 score of 9.00 ±1.3 and FIB-4 score of 1.90±0.15, SGLT2i (+/- ins) PHQ-9 score of 9.40±1.2 and FIB-4 score of 2.50±0.39, Metformin (+/- ins) PHQ-9 score of 10.91±1.5 and FIB-4 score of 1.76±0.16, Insulin only PHQ-9 score of 10.92±1.9 and FIB-4 score of 1.93±0.10.
Conclusion: In T2DM veterans depression scores were lower in patients taking the GLP1RA and SGLT2i. However Metformin group appeared to have least correlation with FIB-4 score. However taking both depression and MASLD parameters into account GLP1A appears to have the best positive correlation.
J. Khoury: None. J. Davis: None. S. Sen: None.
