Non-alcoholic fatty liver disease (NAFLD) affects 30% of the global population and is closely linked with type 2 diabetes (T2DM) and metabolic syndrome. Its progression ranges from simple liver fat accumulation to non-alcoholic steatohepatitis (NASH), fibrosis, and liver cancer. Given insulin resistance’s central role in both NAFLD and T2DM, anti-diabetic medications, including metformin, pioglitazone, SGLT2 inhibitors (SGLT2i), and GLP-1 receptor agonists (GLP1 RAs), have been explored as potential treatments for NAFLD.
While metformin and DPP-4 inhibitors show inconsistent results, pioglitazone, SGLT2i, and GLP1 RAs demonstrate promising outcomes, particularly in reducing liver fat and improving NASH. Pioglitazone remains the only approved treatment for NASH with significant fibrosis, but concerns about weight gain and cancer risk limit its widespread use. SGLT2i and GLP1 RAs show effectiveness, with SGLT2i emerging as the most efficient in head-to-head trials. However, larger studies are needed to evaluate these drugs’ benefits for non-diabetic NAFLD patients, as current approval remains limited to those with specific comorbidities like heart or renal failure.
Reference: Zachou M, Flevari P, Nasiri-Ansari N, et al. The role of anti-diabetic drugs in NAFLD. Have we found the Holy Grail? A narrative review. Eur J Clin Pharmacol. 2024 Jan;80(1):127-150. doi: 10.1007/s00228-023-03586-1. Epub 2023 Nov 8. PMID: 37938366; PMCID: PMC10781828.
