Add on pioglitazone effective for type 2 diabetes patients with alcoholic fatty liver disease

Findings from the retrospective single-centre trial, published in Diabetology International, found that pioglitazone dose did not impact weight gain but notably reduced HbA1c level in patients with or without fatty liver (FL). In patients with fatty liver disease, the decrease in HbA1c level was significantly more pronounced compared to those without fatty liver disease.

NAFLD (Non-alcoholic fatty liver disease) and type 2 diabetes share pathophysiological mechanisms and possible therapeutic strategies. Pioglitazone, an antidiabetic medication used for treating type 2 diabetes, improves function in type 2 diabetes patients with alcoholic fatty liver disease; however, there is no clarity on its efficacy in type 2 diabetes complicated with alcoholic fatty liver disease. Therefore, Masahiro Asakawa and colleagues from Japan investigated whether pioglitazone ameliorates liver dysfunction in type 2 diabetes patients with AFLD in a retrospective single-centre trial.

Pioglitazone's effects were compared across groups using medical record data on changes in body weight; aspartate aminotransferase (AST), HbA1c, gamma-glutamyl transpeptidase (γ-GTP) and alanine aminotransferase (ALT) levels; and fibrosis-4 (FIB-4) index. The study included 100 T2D patients receiving three months of additional pioglitazone. They were divided into those with or without fatty liver, and those with fatty liver were divided further into NAFLD (n=57) and AFLD (n = 21) groups.

The study led to the following findings:

• The dose of pioglitazone (mean dose: 10.6 ± 4.6 mg/day) did not impact weight gain but significantly reduced the HbA1c level in patients with or without FL.
• The reduction in HbA1c level was significantly more pronounced in patients with fatty liver than those without fatty liver.
• In patients with FL, the levels of HbA1c, ALT, AST, and γ-GTP significantly decreased after pioglitazone treatment than before.
• The ALT and AST levels, but not the γ-GTP level, and the FIB-4 index significantly reduced after pioglitazone addition in the AFLD group, comparable to that in the NAFLD group. Following low-dose pioglitazone treatment (≤ 7.5 mg/day), similar effects were observed in T2D patients with AFLD and NAFLD.

The researchers concluded, "three months of additional pioglitazone treatment improves HbA1c levels in type 2 diabetes patients with alcoholic fatty liver disease."

Reference:

Asakawa, M., Takagi, N., Hamada, D. et al. Efficacy of 3 months of additional pioglitazone treatment in type 2 diabetes patients with alcoholic fatty liver disease. Diabetol Int (2023). https://doi.org/10.1007/s13340-023-00619-z