Treatment of type 2 diabetes and the metabolic syndrome in NAFLD
| Treatment | Indication | Outcome |
|---|---|---|
| Dietary intervention | See table 1 | Escalate treatment if HbA1c >7.5% |
| Metformin | First-line treatment of T2DM | Aids 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 | ||
| Pioglitazone | Second-line treatment of T2DM in NASH | Improve 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 analogue | Third-line treatment of T2DM in NASH | Reduce HbA1c by 1% and average 3 kg weight loss |
| Improve liver enzymes and reduce steatosis56 | ||
| Risk of pancreatitis55 | ||
| Insulin/sulfonylureas | Fourth-line treatment of T2DM in NASH | Lead 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.