Table 2

Treatment of type 2 diabetes and the metabolic syndrome in NAFLD

Dietary interventionSee table 1Escalate treatment if HbA1c >7.5%
MetforminFirst-line treatment of T2DMAids weight loss
Reduces risk of any diabetes-related endpoint, microvascular disease, myocardial infarction (large vessel disease) and all-cause mortality52 53
Reduced HCC risk57 58
PioglitazoneSecond-line treatment of T2DM in NASHImprove insulin sensitivity and reduces hepatic steatosis/steatohepatitis41
18% reduction in death, myocardial infarction and stroke in T2DM45
Consider risks of bladder cancer,43 increased bone loss44 and cardiac failure42
GLP-1 analogueThird-line treatment of T2DM in NASHReduce HbA1c by 1% and average 3 kg weight loss
Improve liver enzymes and reduce steatosis56
Risk of pancreatitis55
Insulin/sulfonylureasFourth-line treatment of T2DM in NASHLead to weight gain that can be detrimental in NAFLD
  • GLP-1, glucagon-like peptide-1; HbA1c, glycosylated haemoglobin; HCC, hepatocellular carcinoma; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; T2DM, type 2 diabetes mellitus.