Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of cirrhosis and hepatocellular carcinoma (HCC) in patients with type 2 diabetes mellitus (T2DM), yet evidence on therapies that modify long-term liver outcomes remains limited. A retrospective population-based cohort study published in Diabetes, Obesity and Metabolism evaluated whether semaglutide use was associated with reduced risk of advanced liver complications in this high-risk population.

The analysis included 71,612 adults with T2DM and no prior cirrhosis or HCC. Of these, 35,806 individuals received semaglutide for at least four consecutive months and were matched to an equal number of controls. Cox proportional hazards models adjusted for demographic variables, body mass index (BMI), smoking status, glycemic control, concurrent antidiabetic therapies, and baseline liver fibrosis risk.

Over a median follow-up of 4,628 days for cirrhosis and 4,090 days for HCC, 245 individuals developed cirrhosis and 21 developed HCC. Semaglutide use showed no association with cirrhosis risk (hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.98-1.77) or HCC risk (HR 0.6, 95% CI 0.21-1.51).

These findings indicate that semaglutide was not associated with reduced incidence of cirrhosis or HCC in adults with T2DM. While semaglutide supports glycemic management, its role in preventing advanced liver outcomes remains uncertain in real-world settings.