Aim <p>Studies have shown an increase in liver stiffness (LS) by liver elastography in patients with type 2 diabetes mellitus (DM) and regression of LS in patients receiving SGLT-2 inhibitors (SGLT-2i). We aimed to investigate liver stiffness and related factors before and after treatment with SGLT-2i in patients with diabetes and heart failure.</p> Methods <p>In our prospective and cross-sectional study, 237 patients with diabetes were included. Patients were divided into 3 groups according to the presence and status of heart failure. Patients were treated with SGLT-2i, and their pre- and post-treatment status was evaluated. LS measurements were performed with FibroScan® Mini 430 device (Echosens, France).</p> Results <p>NT-proBNP levels decreased significantly in all groups, with the most pronounced reduction in the HFrEF group (<i>p</i> &lt; 0.001). Liver stiffness (kPa) also improved significantly in all groups, with the greatest change observed in the HFrEF group (Δ = 2.11 ± 1.1&#xa0;kPa, <i>p</i> &lt; 0.001). Similarly, HbA1c levels showed marked reductions across all groups, with the highest improvement seen in the group without heart failure (Δ = 1.28 ± 0.63%, <i>p</i> &lt; 0.001).</p> Conclusion <p>Our findings reinforce the potential of SGLT-2i therapy to improve liver stiffness and related metabolic and cardiac parameters in diabetic patients, irrespective of heart failure status.</p>