2型糖尿病和肝脏疾病，主要是代谢相关脂肪肝（MAFLD）和罕见的肝硬化，在许多患者中共同存在。这种二重性对医生选择降糖药物有直接的影响，既涉及传统的担忧，也包含近期的新希望。本次更新的综述将考虑肝硬化患者中旧有和新型降糖化合物的药物动力学、耐受性/安全性、益处/风险平衡、对MAFLD的影响以及肝细胞癌的风险。特别关注胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运体2抑制剂。我们正在面临糖尿病和肝脏疾病患者管理中的新范式。通过接受商业销售的新型降糖药物，先前对在肝功能受损的糖尿病患者中使用降糖药物（除胰岛素外）存在安全担忧的不愿使用的态度发生了改变。这些药物具有良好的安全性，并伴随体重减轻和多效应。它们已经证明了改善MAFLD的疗效。然而，仍需要更多具体的研究来证明它们在防止纤维化/肝硬化进展方面的疗效，并确认这一管理糖尿病和肝脏疾病患者的新机会。

Type 2 diabetes and liver disease, mainly metabolic-associated fatty liver disease (MAFLD) and more rarely cirrhosis, coexist in many patients. This duality has direct implications for the physician when choosing glucose-lowering agents, with classical concerns but also recent new hopes.This updated comprehensive review will consider the pharmacokinetics, the tolerance/safety profile, the benefit/risk balance in cirrhosis, the effects on MAFLD and the risk of hepatocellular carcinoma of old and new glucose-lowering compounds in patients with liver disease, with a special focus on glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors.We are currently facing a new paradigm in the management of patients with diabetes and liver disease. From previous reluctance when using antidiabetic agents (except insulin) in diabetic patients with hepatic impairment because of safety concerns, the commercialization of novel glucose-lowering agents has changed the scene. These agents, which have a good safety profile, are associated with weight loss and pleiotropic effects. They have proven their efficacy in improving MAFLD. However, more specific studies are still needed to prove their efficacy in preventing the progression to fibrosis/cirrhosis and confirm this new opportunity for the management of patients with diabetes and liver disease.