Gut and Gastroenterology

Clinical Efficacy of an SGLT2 Inhibitor in Type 2 Diabetes Complicated By Nonalcoholic Fatty Liver Disease and Changes in Body Composition

Author(s): Toru Ishikawa, Michitaka Imai, Saori Endo, Motoi Azumi, Yujiro Nozawa, Tomoe Sano, Akito Iwanaga, Terasu Honma, Toshiaki Yoshida

Background: Sodium–glucose cotransporter 2 inhibitors (SGLT2is) decrease blood glucose levels by inhibiting glucose reabsorption in the kidneys. These inhibitors may exhibit clinical efficacy in type 2 diabetes mellitus (T2DM) patients with nonalcoholic fatty liver disease (NAFLD). To determine whether SGLT2is are useful for treating these patients, computed tomography (CT) was used to examine changes in the liver/spleen ratio (L/S ratio), liver function, visceral adipose tissue indices (VATI), and subcutaneous adipose indices (SATI) in response to treatment. 
Methods: Continuous SGLT2i treatment effect was evaluated for at least 6 months on 36 patients (15 males, 21 females) with T2DM complicated by NAFLD. L/S ratio, visceral fat area, and subcutaneous fat area were measured at least twice. These values with liver function tests were compared before and after treatment. Patient characteristics included body mass index, alanine aminotransferase (ALT), aspartate aminotransferase (AST), hemoglobin (Hb)A1c, and ferritin. 
Results: The 24-week SGLT2i course significant decreased body weight (65.83 ± 13.21 to 62.15 ± 13.28 kg), HbA1c (decreased to 6.14 ± 0.35), serum ferritin (decreased to 77.70 ± 74.02 ng/ml), ALT (decreased to 22.08 ± 16.38 IU/L), and AST (decreased to 25.64 ± 16.38 IU/L). CT revealed improvements in body composition including increase in L/S ratio (from 0.94 ± 0.13 to 1.35 ± 0.15), and decreases in VATI (from 51.04 ± 18.92 to 44.04 ± 20.07 cm2/m2) and SATI (from 75.94 ± 41.72 to 67.55 ± 41.79 cm2/m2).
Conclusion: Thus, treatment with SGLT2i improved all parameters associated with T2DM complicated by NAFLD.

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