Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Diabetes and Endocrinology
  • Diabetes and Endocrinology News
  • Anti-diabetic drug and...

Anti-diabetic drug and NASH: Current Options in 2022

Written By : Dr. Kamal Kant Kohli Published On 2022-06-09T11:06:50+05:30  |  Updated On 13 Dec 2022 12:29 PM IST
Anti-diabetic drug and NASH: Current Options in 2022
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

Introduction and Background

Nonalcoholic steatohepatitis (NASH) is a more aggressive form of nonalcoholic fatty liver disease, which can increase the risk of cirrhosis, advanced liver fibrosis, hepatocellular carcinoma, and liver transplantation.(1,2) Patients with obesity and/or type 2 diabetes mellitus (T2DM) have been linked with a 2- to 3-fold increased risk of NASH and may also lead to more advanced fibrosis and hepatocellular carcinoma in this population.(3,4) While NASH has a number of underlying causes and treatment remains challenging.(5) the increased levels of liver triglycerides resulting from insulin-resistant (IR) dysfunctional adipose tissue is a major alarm.(6,7)

Role of Pioglitazone in T2DM and NASH

Since there is no approved therapy for NASH, looking for ways to prevent or reverse the disease is of utmost importance. As of now, among the insulin sensitizers currently available on the market, only pioglitazone has been shown to have some positive effects on NASH (improved histology and biochemistry).*8-10) In this review, we discuss the rationale for pioglitazone treatment of NASH in patients with T2DM.

Pioglitazone works by activating a peroxisome proliferator-activated receptor (PPARs) in adipose tissue, improving lipid storage, lipid redistribution and glucose utilization.(11) It has a beneficial impact on reducing gluconeogenesis in the liver and lowers insulin resistance in the liver, muscles, and adipose tissue. The efficacy of this agent was proven in an early randomized clinical trails, patients with diabetes or prediabetes and biopsy-proven NASH.8 Based on recent guidelines, pioglitazone improves liver histology in patients with and without T2DM that have biopsy-proven NASH, and it found to be useful in treating such patients.(12,13) According to a clinical guideline published by the American Association of Clinical Endocrinology (AACE-2022), pioglitazone is recommended for patients with T2DM and biopsy-proven NASH.(14) Furthermore, clinicians should consider this drug when NASH is suspected based on elevated plasma aminotransferase levels and noninvasive tests in patients with diabetes.(14) Figure 1 summarizes the benefits of pioglitazone for treating NASH in obese, prediabetes or T2DM patients.


Figure 1: Treatment algorithm for NASH

Evidences from Studies

While not yet established, interventions targeting nonalcoholic fatty liver disease and hepatic IR may decrease the risk of developing T2DM,(15,16) as is evident when pioglitazone is administered to people at risk of diabetes, which reduces the progression from prediabetes to T2DM by 70% to 80%.(17,18) Over 72 weeks, individuals with obesity, prediabetes or T2DM who received placebo progressed at 26.9% compared to 7.9% who received pioglitazone.(19)

A single-center study in 101 persons with obesity, and either prediabetes or T2DM, confirmed the sustained benefit of pioglitazone on glucose and lipid metabolism and NASH over 36 months of follow-up. With pioglitazone treatment (45 mg), 58% of individuals achieved the primary outcome of a reduction of at least 2 points in NAS, while 51% had resolution of NASH (treatment difference of 41% and 32% vs placebo, respectively; both P<0.001 vs placebo).(19) There was also an improvement in the mean fibrosis score (P=0.039).(19) A significant improvement in the resolution of NASH may indicate a specific mechanism of pioglitazone in T2DM.The results of the meta-analysis on NASH patients regardless of the presence of T2DM showed that pioglitazone can significantly improve advanced fibrosis (OR, 3.15; 95% CI: 1.25-7.93; P=0.01), fibrosis of any stage (OR, 1.66; 95% CI: 1.12-2.47; P=0.01).(20) The findings of this meta-analysis suggest that pioglitazone not only reversed the NASH but also improved advanced fibrosis.

A study by Bril et al. compared the metabolic and histologic responses to pioglitazone in patients with and without T2DM. The study highlighted that both patient populations were benefited from pioglitazone, however, after 18-months of follow-up patients with diabetes have shown significantly reduced liver fibrosis and increased adipose tissue insulin sensitivity compared to the patients without diabetes.(21) It was noted that long-term use of pioglitazone for up to 24-months was beneficial in terms of reversal of advanced fibrosis stage in patients with NASH.(22,23) Similar benefits were also observed with patients without diabetes which may prompt the extension for pioglitazone use.

Conclusion

Overall findings suggest that pioglitazone therapy is associated with prevention or delay inNASH in patients with NASH prediabetes and T2DM. Additionally, it can significantly improve metabolic and histologic performance of the liver and insulin sensitivity. However, further studies are needed with large samples and long-term follow-up to determine the efficacy of pioglitazone to better guide clinical decision-making, patient selection and clinical practice guidelines in T2DM with NASH.

Pioglitazone therapy is associated with prevention or delay in NASH in patients with NASH prediabetes and T2DM

References:

[1] Bril F, et al. EndocrinolMetabClin North Am 2016;45:765-781.

[2] Wong RJ, et al. Gastroenterology 2015;148:547-555.

[3]Wang C, et al. Int J Cancer 2012;130:1639-1648.

[4] Bril F, et al. Diabetes Care 2017;40:419-430.

[5] Neuschwander-Tetri BA. Nat Rev GastroenterolHepatol. 2014;11:274-6.

[6] Cusi K. Gastroenterology. 2012;142:711-725.

[7] Neuschwander-Tetri BA. Hepatology. 2010;52:774-88.

[8] Belfort R, et al. N Engl J Med. 2006;355(22):2297–307.

[9] Aithal GP, et al. Gastroenterology. 2008;135(4):1176–84.

[10] Sanyal AJ, et al. N Engl J Med. 2010;362(18):1675–85.

[11] Gastaldelli A, et al. JHEP Rep. 2019;1(4):312e328.

[12] European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). J Hepatol. 2016;64(6):1388–402.

[13] Chalasani N, et al. Hepatology. 2018;67(1):328-357.

[14] Cusi K, et al. EndocrPract. 2022;28(5):528-562.

[15] Ballestri S, et al. J GastroenterolHepatol. 2016;31(5):936e944.

[16] Mantovani A, et al. Diabetes Care. 2018;41(2):372e382.

[17] Espinoza SE, et al. Age (Dordr). 2016;38(5-6):485e493.

[18] Kernan WN, et al. N Engl J Med. 2016;374(14):1321e1331.

[19] Cusi K, et al. Ann Intern Med. 2016;165(5):305-315.

[20] Musso G, et al. JAMA Intern Med. 2017;177(5):633-640.

[21] Bril F, et al. ClinGastroenterolHepatol 2018;16(4):558–566.

[22] Ekstedt M, et al. Hepatology. 2015;61(5):1547-1554.

[23] Angulo P, et al. Gastroenterology. 2015;149(2):389-97.

The Above article has been published under the MD Brand Connect Initiative. For more details click here

Anti-diabetic drugNonalcoholic steatohepatitisNASHfatty liverobesitytype 2 diabetescarcinomaT2DMT2DM patientsPioglitazone
Dr. Kamal Kant Kohli
Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

Show Full Article
Next Story

Editorial

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

Aspirin in Primary Prevention- When to Consider?

Aspirin in Primary Prevention- When to Consider?

Featured image representing medico legal

What's the Role of Expert Opinion in Medical Negligence?

7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

View All

Journal Club Today

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

View All

Health News Today

Health Bulletin 09/ May/ 2025

Health Bulletin 09/ May/ 2025

View All
© 2022 All Rights Reserved.
Powered By: Hocalwire
X
We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok