Daily Dose: Improved Glycemic Control and NAFLD in Type 2 Diabetes

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On January 23, 2023, we reported on a study published in Nutrition, Metabolism, & Cardiovascular Diseases that examined whether glucose lowering can improve nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2D), independent of weight loss.

The study

A post-hoc analysis of clinical data from 637 adults with T2D (60% men; mean age, 61.6 years) attending a clinic in Italy who were prescribed a GLP-1RA, SGLT-2i, or DPP-IVi from 2014 to 2017. Over a 12-month period, liver ultrasounds were performed routinely for all participants, and FLI and FIB-4 were calculated as surrogate markers of fatty liver and fibrosis, respectively. Participants with a ≥1% HbA1c reduction were deemed “good glycemic responders” to therapy, those with an HbA1c reduction of 0.1% to 0.9% were “moderate glycemic responders,” and those with no change or an increase in HbA1c were defined as “glycemic nonresponders.”

After 1 year, good glycemic responders had a HbA1c reduction from 8.9% to 6.86%, moderate glycemic responders had a reduction from 7.89% to 7.39%, and glycemic nonresponders had an increase from 7.59% to 8.23%. Multiple linear regression analysis showed a significant correlation between the change in HbA1c and change in FLI after adjustment for change in BMI, age, sex, and drug class (r=0.467, P=.031).The greatest reduction in FLI was seen in participants with the largest reduction in HbA1c (P<.0001). At 1 year, researchers noted a positive correlation between change in HbA1c and Fib-4 after adjusting for change in BMI, sex, age, drug classes, and FIB-4 at baseline (r=0.666, P=.001).

Clinical implications

"Whilst weight loss must be the key priority in treating patients with NAFLD, these data suggest that optimization of glycemic control independently of weight should be an important part of the management of patients with NAFLD. However, they do not replace the need for prospective, well-designed, randomized controlled studies to specifically address the quantitative impact of optimization of glucose control in patients with NAFLD.”

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