Liraglutide plus metformin benefits T2D patients with NAFLD

Use of liraglutide in obese patients with type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD) receiving metformin yields favourable effects on liver fat content and abdominal adiposity, with additional benefits of inducing weight loss and improving liver function, as compared with insulin glargine and placebo, a study reports.

The analysis included 91 patients (average age, 53 years; 59.3 percent male; average weight, 83 kg) with T2D and NAFLD with blood sugar levels inadequately controlled (HbA1c >6.5 percent) on metformin monotherapy (at a stable dose of 20,000 mg/day for at least 3 months) and body mass index >25 kg/m² at baseline. These patients were randomized to receive add-on therapy with insulin glargine (n=30), liraglutide (n=31), or placebo (n=30) for 26 weeks.

At treatment conclusion, intrahepatic content of lipid (IHCL) significantly decreased with liraglutide but only modestly with insulin glargine as compared with placebo (–6.3 percent and –3.4 percent vs –0.1 percent; p<0.05 and p>0.05, respectively).

Both liraglutide and insulin glargine produced marked reductions in subcutaneous adipose tissue (SAT; –36 and –24.5 vs –7.1 cm²; p<0.05 for both) and visceral adipose tissue (VAT; –47 and –16.6 vs –3.5 cm²; p<0.05 for both). The changes in both parameters were significantly greater with liraglutide than insulin glargine (p<0.05).

Furthermore, the liraglutide group achieved meaningful improvements in liver function (measured using aspartate transaminase and alanine transaminase), Homeostatic Model Assessment of Insulin Resistance, as well as in body weight and waist circumference.

The glucose-lowering effect was similar across the three treatment groups. Safety was up to standard.

In light of the findings, liraglutide should be the second-line drug of choice in the treatment of obese patients with T2D and NAFLD.