Pioglitazone confers benefits for fatty liver in patients with type 2 diabetes

Treatment with pioglitazone, even at low doses, helps improve indices of nonalcoholic fatty liver disease (NAFLD) such as liver steatosis, inflammation, and systemic and adipose tissue insulin resistance in patients with type 2 diabetes, according to a study.

The analysis included 195 patients aged 50–75 years with poorly controlled diabetes on metformin 2 g/day. These patients were randomized to receive add-on pioglitazone (n=98) or sulphonylureas (n=97) for 1 year within the TOSCA.IT trial.

Researchers assessed plasma insulin, glucose, and liver enzymes at baseline and after 1 year of treatment. They also calculated indirect indices of NAFLD (Liver Fat Equation [LFE], Hepatic Steatosis Index [HSI], and Index of NASH [ION]), and insulin resistance (HOMA-IR, Visceral Adiposity Index [VAI], and adipose tissue Insulin Resistance [ADIPO-IR]).

At treatment conclusion, the NAFLD indices improved with pioglitazone but not with sulphonylureas. The respective changes from baseline were –1.76 vs 0.28 for LFE, –1.35 vs –0.27 for HSI, and –9.75 vs 3.24 for ION (p<0.05 for all).

Likewise, indices of insulin resistance decreased with pioglitazone but not with sulphonylureas. The corresponding changes were –0.95 vs 0.37 for HOMA-IR (p=0.032), –1.25 vs 1.36 for ADIPO-IR (p=0.001), and –0.53 vs 0.03 for VAI (p=0.074).

The improvements observed in NAFLD indices were consistent across different doses of pioglitazone (15, 30, or 45 mg/day) and were independent of blood glucose control.