American Diabetes Association releases guideline update on NAFLD in People with diabetes

Pioglitazone/GLP1 RA are the preferred agents for the treatment of hyperglycemia in people with T2DM diabetes with NAFLD or those at high risk of NAFLD, a recent guidance update released by ADA has stated.

The 2023 ADA guidance update on NAFLD aligns with those of other professional societies, such as AASLD and American Association of Clinical Endocrinology (AACE) and has given a Grade A recommendation to Pioglitazone or GLP1 RA as preferred agents for the treatment of hyperglycemia in T2DM with biopsy-proven nonalcoholic steatohepatitis or high risk NAFLD patients with clinically significant liver fibrosis, along with non-invasive screening guidelines.

Pioglitazone is a peroxisome proliferator–activated receptor γ (PPARγ) agonist that ameliorates insulin resistance and improves glucose and lipid metabolism in type 2 diabetes. Pioglitazone has been shown to significantly improve the histological changes in the liver of NAFLD patients, primarily fibrosis, hepatocellular ballooning, lobular ballooning, steatosis, and liver enzymes.

The ADA now advises universal screening of people with type 2 diabetes and prediabetes for fatty liver disease using FIB-4 criteria. Liver disease affects up to 70% of people with type 2 diabetes, and hepatic toxicity is a prominent feature; thus, pioglitazone, an insulin sensitizer, makes it useful in treating this population.