Effects of anti-diabetic treatments in type 2 diabetes and fatty liver disease

ABSTRACT

Introduction: Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are significant non-communicable diseases that often affect individuals concurrently. In individuals with both T2DM and NAFLD, there is evidence that anti-diabetic therapies may demonstrate potential combined beneficial metabolic and reduced hepatic inflammatory effects.

Areas covered: A PubMed and Google Scholar search was performed to find relevant literature. Included studies focused on individuals with T2DM and NAFLD receiving anti-diabetic treatments including bariatric surgery, insulin sensitizers, incretin mimetics, and SGLT2 inhibitors. Additional articles highlight investigational treatments.

Expert opinion: In individuals with T2DM and NAFLD, 5–10% weight loss or bariatric surgery if unable to lose weight or maintain weight loss are appropriate. GLP-1 receptor agonists and SGLT2 inhibitors result in weight loss, appear safe and may provide beneficial hepatic outcomes. Whether their effects are related to favorable weight changes or intrinsic hepatic effects is unclear. Thiazolidinediones have advantageous anti-hyperglycemic and hepatic effects but individuals must be monitored for weight gain and edema. Metformin and DPP-4 inhibitor beneficial hepatic effects remain debated. There are opportunities to standardize markers and imaging of NAFLD. Studies powered to evaluate the possible cardiovascular benefits of anti-diabetic therapies in individuals with T2DM and NAFLD are needed.

KEYWORDS:

• Bariatric surgery
• diabetes mellitus
• dipeptidyl-peptidase −4 inhibitors
• nonalcoholic fatty liver disease
• metformin
• Sodium-glucose cotransporter-2 inhibitors
• Thiazolidinediones
• weight loss

Article highlights

• Using existing antihyperglycemic strategies that have beneficial hepatic effects is advantageous in individuals with both NAFLD and T2DM

• 5−10% weight loss or bariatric surgery is an effective treatment strategy for both diseases

• Thiazolidinediones are an approved and effective treatment for both diseases

• Metformin and dipeptidyl-peptidase −4 inhibitors effects are unclear in NAFLD

• GLP-1 receptor agonists and SGLT2 inhibitors result in weight loss and show promise in improving NAFLD

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.