The Effect of Empagliflozin on Liver Fat in Type 2 Diabetes Mellitus Patients With Non-Alcoholic Fatty Liver Disease.

Arbinda Pokharel,Mukesh S Paudel,Sudhamshu Kc,Pukar Thapa,Rupesh Shrestha,Bikash Jaishi,Niyanta Karki

doi:10.7759/cureus.16687

Abstract

Background and objectiveThe prevalence of non-alcoholic fatty liver disease (NAFLD) is 60% in patients with type 2 diabetes mellitus (T2DM). NAFLD can lead to non-alcoholic steatohepatitis (NASH), both of which are the leading causes of cirrhosis. This study was undertaken to evaluate whether empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, reduces liver fat content in these patients after therapy.MethodsAfter enrolling patients of T2DM with NAFLD, they were administered empagliflozin 10 mg once daily orally for six months without modifying existing oral hypoglycemic agents (OHA) if any. All demographic data were collected, and anthropometric measurements, as well as laboratory investigations, were performed, and controlled attenuation parameter (CAP) and liver stiffness (LS) were measured using FibroScan® (Echosens, Paris, France) at baseline, and six months of therapy. The adverse effects related to therapy were also taken into account.ResultsThere was a significant decrease in mean CAP value from 282.07 ± 47.29 dB/m to 263.07 ± 49.93 dB/m and LS from 5.89 ± 4.23 kPa to 5.04 ± 1.49 kPa along with a significant decrease in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) among the patients. Compared to the baseline, there was a significant reduction in post-treatment weight, body mass index (BMI), and blood pressure (BP). The most commonly observed adverse effects of the therapy were urinary tract infection (UTI) (17.8%), nasopharyngitis (11.9%), and hypoglycemia (10.71%).ConclusionA reduction in hepatic fat content was seen in our prospective study cohort after six months of empagliflozin therapy. Empagliflozin also led to beneficial effects such as weight loss and reduction in transaminases and GGT. Given the absence of significant side effects of the therapy, empagliflozin could be used as an effective treatment modality for T2DM patients with NAFLD, which are two conditions commonly seen in combination.

Highlights

Non-alcoholic fatty liver disease (NAFLD) is defined as hepatic steatosis diagnosed by histology or imaging with macrovesicular steatosis in >5% of hepatocytes [1]
There was a significant decrease in mean controlled attenuation parameter (CAP) value from 282.07 ± 47.29 dB/m to 263.07 ± 49.93 dB/m and liver stiffness (LS) from 5.89 ± 4.23 kPa to 5.04 ± 1.49 kPa along with a significant decrease in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) among the patients
There was a significant reduction in post-treatment weight, body mass index (BMI), and blood pressure (BP)

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is defined as hepatic steatosis diagnosed by histology or imaging with macrovesicular steatosis in >5% of hepatocytes [1]. The prevalence of NAFLD is 59.67% in patients with type-2 diabetes mellitus (T2DM). A novel parameter to assess steatosis is by a vibration-controlled transient elastography device, which measures controlled attenuation parameter (CAP). It measures the increased attenuation of ultrasound waves when traveling through steatotic hepatic tissue, compared to normal liver. It is noninvasive, quantitative, and non-ionizing [5,6]. The prevalence of non-alcoholic fatty liver disease (NAFLD) is 60% in patients with type 2 diabetes mellitus (T2DM). This study was undertaken to evaluate whether empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, reduces liver fat content in these patients after therapy

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Discussion

Conclusion