Effect of incretin therapies compared to pioglitazone and gliclazide in non-alcoholic fatty liver disease in diabetic patients not controlled on metformin alone: An observational, pilot study

Eduardo García Díaz , Danila Guagnozzi , Verónica Gutiérrez , Carmen Mendoza , Cristina Maza , Yulene Larrañaga , Dolores Perdomo , Teresa Godoy , Ghalli Taleb
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Abstract

Aim

To compare the effect of different hypoglycemic drugs on laboratory and ultrasonographic markers of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes not controlled on metformin alone.

Methods

Prospective study of diabetic patients treated with metformin in combination with gliclazide, pioglitazone, sitagliptin, exenatide, or liraglutide. NAFLD was assessed by abdominal ultrasound and NAFLD fibrosis score was calculated at baseline and 6 months.

Results

Fifty-eight patients completed 6 months of follow-up: 15 received gliclazide, 13 pioglitazone, 15 sitagliptin, 7 exenatide, and 8 liraglutide. NAFLD affected 57.8% of patients at baseline, and its ultrasonographic course varied depending on changes in weight (P = .009) and waist circumference (P = .012). The proportions of patients who experienced ultrasonographic improvement in the different treatment groups were: 33.3% with gliclazide, 37.5% with pioglitazone, 45.5% with sitagliptin, 80% with exenatide, and 33% with liraglutide (P = .28).

Conclusions

Qualitative ultrasonographic NAFLD improvement in diabetic patients treated with metformin in combination with other hypoglycemic drugs is associated to change over time in weight and waist circumference. Long-term clinical trials are needed to assess whether incretin therapies result in better liver outcomes than other hypoglycemic therapies.

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肠促胰岛素治疗与吡格列酮和格列齐特治疗未单独使用二甲双胍控制的糖尿病患者非酒精性脂肪肝的疗效比较:一项观察性初步研究
目的比较不同降糖药物对未单独使用二甲双胍控制的2型糖尿病患者非酒精性脂肪肝(NAFLD)实验室和超声标记物的影响。方法对糖尿病患者进行二甲双胍联合格列齐特、吡格列酮、西他列汀、艾塞那肽或利拉鲁肽治疗的前瞻性研究。通过腹部超声评估NAFLD,并在基线和6个月时计算NAFLD纤维化评分。结果58例患者完成了6个月的随访:15例接受了格列齐特、13例吡格列酮、15例西他列汀、7例艾塞那肽和8例利拉鲁肽。NAFLD在基线时影响了57.8%的患者,其超声病程因体重(P=.009)和腰围(P=.012)的变化而变化。不同治疗组中超声改善的患者比例为:格列齐特组33.3%,吡格列酮组37.5%,西他列汀组45.5%,艾塞那肽组80%,利拉鲁肽组为33%(P=.28)。结论二甲双胍联合其他降血糖药物治疗的糖尿病患者NAFLD的定性超声改善与体重和腰围随时间的变化有关。需要进行长期临床试验来评估肠促胰岛素治疗是否比其他降血糖治疗能带来更好的肝脏结果。
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