Endocrine Abstracts

Aim: The current focus for the treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) is lifestyle intervention with the aim of significant weight loss. NAFLD is tightly associated with type 2 diabetes (T2D) and obesity. In patients with T2D, glucose lowering agents that promote weight loss have shown a beneficial impact on NAFLD. However, it remains unclear as to whether glucose lowering can improve NALFD in patients with T2D, independent of weight loss.

Methods: In a retrospective analysis of data from 802 people with T2D, we examined the longitudinal impact of optimizing glycaemic control with DPP-IV inhibitors, GLP-1RAs and SGLT2 inhibitors on Fatty liver index (FLI) and Fibrosis score 4 (Fib-4) adjusting for changes in BMI and choice of glucose lowering regimen over a 12-month period.

Results: At baseline, FLI correlated with glycated haemoglobin, even after adjustment for BMI (r=0.734, P=0.014). Linear regression analysis demonstrated a significant correlation between the change in glycated haemoglobin and change in FLI after adjustment for change in BMI, age, sex, and drug class (r=0.467, P=0.031). The greatest reduction in FLI was observed in patients with the largest reduction in glycated haemoglobin (P<0.0001). The probability of improvements in FLI with optimization of glycaemic control was similar with all 3 glucose lowering agents, despite differences in weight reduction. Similar relationships were observed examining the changes in glycaemic control and Fib-4.

Interpretation: Improvements in glucose control that are independent of weight loss are associated with improvement in NAFLD and should form an integral part of the management of patients with co-existent NAFLD and T2D.