Optimal glycemic control in patients with type 2 diabetes may ward off development of non-alcoholic fatty liver disease (NAFLD) or improve the stage of fatty liver disease, according to a study published in the journal Nutrition, Metabolism & Cardiovascular Diseases.¹

A team of researchers from the UK and Italy retrospectively analysed medical records of 637 patients with type 2 diabetes. Through this study conducted from 2014 to 2017, they aimed to examine if optimal glycemic control influenced Fatty liver index (FLI) and Fibrosis score 4 (Fib-4), the markers of fatty liver disease. The study participants, aged 61.6 years (mean), were taking GLP-1RAs, DPP-IV inhibitors and SGLT2 inhibitors for their diabetes.

After one year of treatment, 44% patients were found to be good glycemic responders with decline in HbA1c of ≥1% from 8.9% to 6.86% (mean), 36% were moderate glycemic responders with decline in HbA1c of 0.1-0.9% from 7.89% to 7.39% (mean), while 20% were nonresponders with increase in HbA1c from 7.59% to 8.23%.

Any change in HbA1c was associated with change in fatty liver index at one year; this association remained statistically significant even after adjusting for BMI, age, sex and drug class (r = 0.706). The maximum reduction in Fatty liver index was seen among the good glycemic responders. The reduction in FLI was smaller among the moderate responders, while in the nonresponder group, the FLI showed no change. Drug class had no impact on the likelihood of improvement in FLI, regardless of the differences in weight loss. Similar associations were noted between changes in HbA1c and Fib-4 with the greatest reduction seen among the good glycemic responder group.

Reduction in waist circumference and BMI was noted in all the three groups at one year. Total cholesterol reduced among the good and moderate glycemic responders. Only the good glycemic responders showed decline in alanine transaminase (ALT) levels. Systolic and diastolic BPs also reduced in all groups.

Lifestyle modification aiming at weight loss and cardiometabolic risk reduction is currently the approach for NAFLD, which often coexists with type 2 diabetes. Anti-hyperglycemic drugs that cause weight loss have been shown to have a beneficial effect on NAFLD. This study has shown that optimal glycemic control favorably impacted fatty liver disease independent of weight loss and the anti-diabetic drugs prescribed. While emphasizing the multidisciplinary approach to the management of patients with NAFLD, it also highlights optimal glycemic control as an important component of outpatient management of NAFLD with type 2 diabetes.

Reference

1. Colosimo S, et al. Improved glycaemic control in patients with type 2 diabetes has a beneficial impact on NAFLD, independent of change in BMI or glucose lowering agent. Nutr Metab Cardiovasc Dis. Dec. 21, 2022. https:// doi.org/10.1016/j.numecd.2022.12.010.