Effects of sodium-glucose cotransporter 2 inhibitors on non-alcoholic fatty liver disease in patients with type 2 diabetes: A meta-analysis of randomized controlled trials - PubMed (original) (raw)

Meta-Analysis

. 2020 Sep;11(5):1238-1247.

doi: 10.1111/jdi.13237. Epub 2020 Mar 25.

Affiliations

Meta-Analysis

Effects of sodium-glucose cotransporter 2 inhibitors on non-alcoholic fatty liver disease in patients with type 2 diabetes: A meta-analysis of randomized controlled trials

Baodi Xing et al. J Diabetes Investig. 2020 Sep.

Abstract

Aims/introduction: Non-alcoholic fatty liver disease (NAFLD) is increasingly common in patients with type 2 diabetes mellitus. Currently, some studies have found that sodium-glucose cotransporter 2 (SGLT2) inhibitors, a new hypoglycemic drug, can improve non-alcoholic fatty liver in addition to its hypoglycemic effect. Thus, we undertook a meta-analysis of randomized controlled trials to evaluate the efficacy of SGLT2 inhibitors on the treatment of NAFLD.

Materials and methods: PubMed, Embase and the Cochrane Library were searched for randomized controlled trials of SGLT2 inhibitors in patients with NAFLD and type 2 diabetes mellitus up to 1 October 2019. Differences were expressed as weight mean difference (WMD) with 95% confidence interval (CI) for continuous outcomes. The I2 statistic was applied to evaluate the heterogeneity of studies.

Results: A total of six trials including 309 patients were selected into our meta-analysis. SGLT2 inhibitors could reduce alanine aminotransferase (WMD -11.05 IU/L, 95% CI -19.85, -2.25, P = 0.01) and magnetic resonance imaging proton density fat fraction (WMD -2.07%, 95% CI -3.86, -0.28, P = 0.02). However, SGLT2 inhibitors did not reduce aspartate aminotransferase (WMD -1.11 IU/L, 95% CI -2.39, 0.17, P = 0.09). In addition, secondary outcomes, such as bodyweight and visceral fat area, were also reduced (WMD -1.62 kg, 95% CI -2.02, -1.23, P < 0.00001; WMD -19.98 cm2 , 95% CI -27.18, -12.79, P < 0.00001, respectively).

Conclusions: SGLT2 inhibitors can significantly decrease alanine aminotransferase and liver fat, accompanied with weight loss, which might have a positive effect on fatty liver in patients with type 2 diabetes mellitus. The limitation is that the sample size of the studies was small. Therefore, more large randomized controlled trials specified on NAFLD are required to evaluate these results.

Keywords: Non-alcoholic fatty liver disease; Sodium-glucose cotransporter 2 inhibitors; Type 2 diabetes mellitus.

© 2020 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1

Figure 1

Flow chart of literature selection. RCTs, randomized controlled trials.

Figure 2

Figure 2

(a) Forest plots showing alanine aminotransferase level comparisons between sodium–glucose cotransporter 2 (SGLT2) inhibitors and the control group. (b) Forest plots showing aspartate aminotransferase level comparisons between SGLT2 inhibitors and the control group. (c) Forest plots showing magnetic resonance imaging proton density fat fraction comparisons between SGLT2 inhibitors and the control group. (d) Forest plots showing visceral fat areas comparisons between SGLT2 inhibitors and the control group. (e) Forest plots showing bodyweight comparisons between SGLT2 inhibitors and the control group. CI, confidence interval; SD, standard deviation.

Figure 3

Figure 3

Forest plots depicting glycated hemoglobin comparisons between sodium–glucose cotransporter 2 inhibitors and the control group. CI, confidence interval; SD, standard deviation.

Figure 4

Figure 4

Forest plots depicting alanine aminotransferase level comparisons between sodium–glucose cotransporter 2inhibitors and the control group based on the control. CI, confidence interval; SD, standard deviation.

References

    1. Adams LA, Anstee QM, Tilg H, et al Non‐alcoholic fatty liver disease and its relationship with cardiovascular disease and other extra‐hepatic diseases. Gut 2017; 66: 1138–1153. - PubMed
    1. Williams CD, Stengel J, Asike MI, et al Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle‐aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology 2011; 140: 124–131. - PubMed
    1. Adams LA, Lymp JF, St Sauver J, et al The natural history of nonalcoholic fatty liver disease: a population‐based cohort study. Gastroenterology 2009; 129: 113–121. - PubMed
    1. Williamson RM, Price JF, Glancy S, et al Prevalence of and risk factors for hepatic steatosis and nonalcoholic fatty liver disease in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Diabetes Care 2011; 34: 1139–1144. - PMC - PubMed
    1. Targher G, Byrne CD, Lonardo A, et al Non‐alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta‐ analysis. J Hepatol 2016; 65: 589–600. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources