Low- dose Pioglitazone improves NAFLD in type 2 diabetes: Study

Non-Alcoholic Fatty Liver Disease (NAFLD) and type 2 diabetes have similar pathophysiological mechanisms and potential treatment methods.

A study was performed by Pepa G et. al to assess the effects of 1-year treatment with pioglitazone or sulphonylureas on indirect indices of NAFLD in patients with type-2 diabetes and the role of insulin resistance as well as glucotoxicity in determining these effects.

The researchers selected a total of 195 type-2 diabetes patients belonging to the age group of 50-75 years, with inadequately controlled blood sugar levels and receiving metformin 2 g/day. All the participants were randomly allocated to either add-on pioglitazone (n=98) or sulphonylureas (n=97) within the TOSCA.IT trial.

Plasma insulin, glucose, and liver enzymes were measured at baseline and after 1-year. Indirect indices of NAFLD (Liver Fat Equation [LFE], Hepatic Steatosis Index [HSI], and Index of NASH [ION]), and insulin resistance (HOMA-IR, Visceral Adiposity Index [VAI] and adipose tissue Insulin Resistance [ADIPO-IR]) were calculated.

The findings of the study are as follows:

· NAFLD indices improved after pioglitazone, but not after sulphonylureas; Indices of insulin resistance decreased after pioglitazone, but not after sulphonylureas.

· Changes in NAFLD indices were similar with different doses of pioglitazone (15, 30, or 45 mg/day), and were independent of blood glucose control level.

The researchers concluded that one-year treatment with pioglitazone even at low dosage drastically improved liver steatosis, inflammation, systemic and adipose tissue insulin resistance in patients with type-2 diabetes. Also, the beneficial effects of pioglitazone on NAFLD was independent of blood glucose control level.

Reference:

A study titled, "Pioglitazone even at low dosage improves NAFLD in type 2 diabetes: clinical and pathophysiological insights from a subgroup of the TOSCA.IT randomized trial" by Pepa G et. al published in the Diabetes Research and Clinical Practice

DOI: https://doi.org/10.1016/j.diabres.2021.108984