Glucagon-like peptide 1 receptor agonists in the treatment of patients with type 2 diabetes and metabolically-associated steatosic liver disease. Review

Abstract

In recent years, the prevalence of metabolically‑associated steatosis of the liver (MASLD) in patients with type 2 diabetes mellitus (T2DM) has been increasing significantly. Therefore, there is an urgent need to study new strategies for the treatment of this pathology, in particular, to prevent the progression of liver steatosis and fibrosis and to reduce the mortality associated with liver diseases. A systematic review and meta‑analysis of randomized controlled trials was recently conducted to assess the efficacy and safety of glucagon‑like peptide‑1 receptor agonists (GLP‑1RAs) in the treatment of hepatic steatosis and fibrosis in patients with T2DM s and MASLD. A total of eight trials were included in the review, involving a total of 468 participants with T2DM and MASLD. Analysis of the primary results showed that administration of GLP‑1RAs in patients with T2DM and MASLD significantly reduced the content of intrahepatic fat, subcutaneous adipose tissue, and visceral adipose tissue. Analysis of secondary outcomes showed that GLP‑1RAs caused significant reductions in alanine aminotransferase, aspartate aminotransferase, body weight, body mass index, waist circumference, fasting blood glucose and HbA1c, HoMA‑IR insulin resistance index, total cholesterol and triglycerides compared with the control schemes of treatment. The main adverse events associated with GLP‑1RAs included mild to moderate gastrointestinal discomfort and hypoglycemia, which resolved within several weeks. GLP‑1 RAs have a positive effect in patients with T2DM and MASLD and have a positive effect on inflammatory markers, contribute to reducing of weight, waist circumference, and insulin resistance index. Therefore, GLP‑1RAs can be considered as a potential treatment strategy for patients with type 2 diabetes and MASLD, if there are no contraindications. Further studies are needed to clearly understand the effect of GLP‑1RAs on the course of MASLD and the potential mechanisms by which they exert a therapeutic effect and prevent its progression.