Improved glycaemic control in patients with type 2 diabetes has a beneficial impact on NAFLD, independent of change in BMI or glucose lowering agent

Santo Colosimo; Garry D Tan; Maria Letizia Petroni; Giulio Marchesini; Jeremy W Tomlinson

doi:10.1016/j.numecd.2022.12.010

Improved glycaemic control in patients with type 2 diabetes has a beneficial impact on NAFLD, independent of change in BMI or glucose lowering agent

Nutr Metab Cardiovasc Dis. 2023 Mar;33(3):640-648. doi: 10.1016/j.numecd.2022.12.010. Epub 2022 Dec 21.

Authors

Santo Colosimo¹, Garry D Tan², Maria Letizia Petroni³, Giulio Marchesini³, Jeremy W Tomlinson⁴

Affiliations

¹ School of Nutrition Science, University of Milan, Milan, Italy; Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK.
² Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK.
³ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁴ Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK. Electronic address: jeremy.tomlinson@ocdem.ox.ac.uk.

PMID: 36710114
DOI: 10.1016/j.numecd.2022.12.010

Abstract

Background and aim: The current focus of the treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) is lifestyle intervention with the aim of significant weight loss alongside aggressive cardiovascular risk reduction. NAFLD is tightly associated with type 2 diabetes (T2D) and obesity. In patients with T2D, glucose lowering agents that promote weight loss have shown a beneficial impact on NAFLD. However, it remains unclear as to whether glucose lowering can improve NALFD in patients with T2D, independent of weight loss.

Methods and results: In a retrospective analysis of data from 637 people with T2D, we examined the longitudinal impact of optimizing glycaemic control with DPP-IV inhibitors, GLP-1RAs and SGLT2 inhibitors on Fatty liver index (FLI) and Fibrosis score 4 (Fib-4) adjusting for changes in BMI and choice of glucose lowering regimen over a 12-month period. Multiple linear regression analysis demonstrated a significant correlation between the change in glycated haemoglobin and change in FLI after adjustment for change in BMI, age, sex, and drug class (R = 0.467, p = 0.031). The greatest reduction in FLI was observed in patients with the largest reduction in glycated haemoglobin (p < 0.0001). The probability of improvements in FLI with optimization of glycaemic control was similar with all 3 glucose lowering agents, despite differences in weight reduction. Similar relationships were observed examining the changes in glycaemic control and Fib-4.

Conclusions: Improvements in glucose control that are independent of weight loss are associated with improvement in NAFLD and should form an integral part of the management patients with co-existent NAFLD and T2D.

Keywords: DPP-IVi; Fatty liver Index; Fib-4; GLP-1RA; Glucose control; NAFLD; SGLT2i; T2DM.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / drug therapy
Glucose
Glycated Hemoglobin
Glycemic Control
Humans
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / diagnosis
Non-alcoholic Fatty Liver Disease* / drug therapy
Retrospective Studies
Weight Loss

Substances

Glycated Hemoglobin
Glucose

Grants and funding

MR/P011462/1/MRC_/Medical Research Council/United Kingdom