Effects of liraglutide, metformin and gliclazide on body composition in patients with both type 2 diabetes and non-alcoholic fatty liver disease: A randomized trial

Abstract

Aims/introduction: To compare the effects of gliclazide, liraglutide and metformin on body composition in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease.

Materials and methods: A total of 85 patients were randomly allocated to receive gliclazide (n = 27), liraglutide (n = 29) or metformin (n = 29) monotherapy for 24 weeks. Body composition was measured using dual-energy X-ray absorptiometry.

Results: Liraglutide and metformin reduced total, trunk, limb, android and gynoid fat mass; this also led to weight reduction. However, gliclazide treatment produced no significant changes in weight or fat mass, likely because reductions in fat mass were concomitant with increases in lean tissue mass. Blood glucose concentrations and glycated hemoglobin levels improved in all treatment arms; levels of the latter were lower in patients treated with liraglutide and metformin. Serum alanine aminotransferase concentrations decreased in all treatment arms, whereas serum aspartate aminotransferase concentrations were reduced only by liraglutide and metformin. In all patients, weight loss and total, trunk, limb, and android fat mass reductions were positively correlated with decreases in serum alanine aminotransferase and aspartate aminotransferase levels, whereas reductions in waist circumference were positively correlated with lower serum alanine aminotransferase levels.

Conclusions: Compared with gliclazide, liraglutide and metformin monotherapies result in greater weight loss, reductions in body fat mass, and better blood glucose control among type 2 diabetes mellitus patients with non-alcoholic fatty liver disease. Reductions in weight, fat mass and waist circumference favorably affect hepatic function.

Keywords: Antidiabetic agents; Body composition; Type 2 diabetes mellitus.

Figure 1

Flowchart of study participants. Of the 93 randomized participants who met the inclusion criteria, eight participants did not complete the study, as they either discontinued follow‐up visits (n = 5) or had protocol violations (n = 3). MR, modified release; NAFLD, non‐alcoholic fatty liver disease; T2DM, type 2 diabetes mellitus.

Figure 2

Changes in fat mass vs changes in lean tissue in the same region with the use of liraglutide, metformin and gliclazide (*P < 0.05, **P < 0.01). Data are shown as the mean ± standard error of the mean.

Figure 3

Glycated hemoglobin (HbA1c) at baseline, and after 12 and 24 weeks of treatment. **P < 0.01, HbA1c compared with respective baseline values for liraglutide, metformin and gliclazide. ^†† P < 0.01, HbA1c in the gliclazide arm compared with the liraglutide arm after 12 weeks of treatment. ^‡‡ P < 0.01, HbA1c in the gliclazide arm compared with liraglutide after 24 weeks of treatment. ^§ P < 0.05, HbA1c in the gliclazide arm compared with metformin after 24 weeks of treatment. Data are shown as the mean ± standard error of the mean.