Ectopic lipid accumulation in the kidney (fatty kidney) is a potential driver of diabetic kidney disease, and tight glycemic control can reduce risk of diabetic nephropathy. We assessed whether glycemic control influences renal triglyceride content (RTGC). Furthermore, we compared glucagon-like peptide-1 receptor agonist liraglutide versus standard glucose-lowering therapy. In this single-center parallel-group trial, patients with type 2 diabetes mellitus were randomized to liraglutide or placebo added to standard care (metformin/sulfonylurea derivative/insulin). Changes in RTGC after 26weeks of glycemic control measured by proton spectroscopy and difference in RTGC between treatment groups were analyzed. Fifty patients with type 2 diabetes mellitus were included in the baseline analysis (mean age, 56.5±9.1years; range, 33-73years; 46% males). Seventeen patients had baseline and follow-up measurements. Mean glycated hemoglobin was 7.8±0.8%, which changed to 7.3±0.9% after 26 weeks of glycemic control irrespective of treatment group (P=.046). Log-transformed RTGC was -0.68±0.30% and changed to -0.83±0.32% after 26 weeks of glycemic control irrespective of treatment group (P=.049). A 26-week-to-̶baseline RTGC ratio (95% confidence interval) was significantly different between liraglutide (-0.30 [-0.50, -0.09]) and placebo added to standard care (-0.003 [-0.34, 0.34]) (P=.04). In this exploratory study, we found that 26weeks of glycemic control resulted in lower RTGC, in particular for liraglutide; however, larger clinical studies are needed to assess whether these changes reflect a true effect of glycemic control on fatty kidney.