Type 2 diabetes and non-alcoholic fatty liver disease: treatment options

This review summarized the treatment options available to type 2 diabetes patients with non-alcoholic fatty liver disease (NAFLD). This review considers current treatment options and possible future treatments. 

Type 2 diabetes (T2D) can lead to multiple complications over time. NAFLD is increasing in patients with T2D, especially in obese patients.  NAFLD is an umbrella term for conditions in which too much fat builds up in the liver Patients with NAFLD have a much higher risk of developing an aggressive liver disease called non-alcoholic steatohepatitis (NASH). NASH causes swelling to the liver and damage to the liver cells. NASH can also lead to cirrhosis of the liver (where the liver becomes scarred and stops working properly) and cardiovascular (heart) disease. T2D patients with NASH have a higher risk of dying from cirrhosis, heart disease, or liver cancer.

This review looked at the best drugs available to treat NAFLD in T2D patients, and future drug developments to improve treatment options. 

Of the current drugs available to treat NASH, pioglitazone (Actos) has resulted in significant improvements. Pioglitazone reverses the excess fat in the liver within six months of starting treatment and continues for at least three years in patients with pre-diabetes or T2D. Pioglitazone was also associated with reduced rates of cardiovascular events.

Glucagon-like peptide 1 (GLP-1) receptor agonists are being examined as a possible treatment option. GLP-1 agonists (such as liraglutide) are used to treat T2D. In one study, patients treated with liraglutide were 4.3 times more likely to see resolution of NAFLD than were patients treated with placebo (substance with no active effect). Other glucose-lowering treatments, SGLT2 inhibitors (such as canagliflozin) are being explored as possible treatments for NAFLD and NASH.

It is likely that a combination of drugs will be used in the future to treat NAFLD. In order to treat the condition early, proper screening and early treatment are needed.

The study concluded that screening would help discover NAFLD earlier, and better treatment options would improve the outcomes and the quality of life for patients.