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Meta-Analysis
. 2021 Apr 28:12:615409.
doi: 10.3389/fendo.2021.615409. eCollection 2021.

Pioglitazone for NAFLD Patients With Prediabetes or Type 2 Diabetes Mellitus: A Meta-Analysis

Jingxuan Lian  1 , Jianfang Fu  1
Affiliations
Meta-Analysis

Pioglitazone for NAFLD Patients With Prediabetes or Type 2 Diabetes Mellitus: A Meta-Analysis

Jingxuan Lian et al. Front Endocrinol (Lausanne). .

Erratum in

Abstract

Objective: To systematically evaluate the effects of pioglitazone in the treatment of patients with prediabetes or T2DM combined with NAFLD.

Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and ClinicalTrials databases were searched until August 2020 for publications written in English. Two reviewers independently assessed study eligibility, continuous data extraction, independent assessment of bias risk, and graded the strength of evidence. Our primary outcomes were the individual number of patients with improvement of at least 1 point in each of the histological parameters. Baseline characteristic data, such as BMI, weight, total body fat, fasting plasma glucose and fasting plasma insulin, and liver biological indicators, such as triglyceride level, HDL cholesterol level, plasma AST, and plasma ALT, were used as secondary outcomes.

Results: A total of 4 studies were included. Compared with placebo, pioglitazone significantly improved steatosis grade, inflammation grade and ballooning grade, while in the fibrosis stage, there was no significant improvement in pioglitazone compared with placebo. In addition, pioglitazone can also improve blood glucose and liver function.

Conclusion: Pioglitazone can significantly improve the histological performance of the liver and insulin sensitivity. Additionally, it can significantly reduce fasting blood glucose, glycosylated hemoglobin, plasma AST, ALT and other liver biological indicators. Due to the lack of relevant randomized controlled trials and short intervention times, long-term studies are still needed to verify its efficacy and safety.

Systematic review registration: [PROSPERO], identifier [CRD42020212025].

Keywords: NAFLD; meta-analysis; pioglitazone; prediabetes; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart showing the process for inclusion of RCTs about patients with prediabetes or T2DM combined with NAFLD. RCTs, randomized clinical trials.
Figure 2
Figure 2
Risk of bias summary for review authors’ judgments about each risk of bias item for each included study.
Figure 3
Figure 3
The effect of pioglitazone in hepatic histologic scores(steatosis grade) with improvement of at least 1 grade (A); The effect of pioglitazone in hepatic histologic scores(Inflammation grade) with improvement of at least 1 grade (B); The effect of pioglitazone in hepatic histologic scores(ballooning grade) with improvement of at least 1 grade (C); The effect of pioglitazone in hepatic histologic scores(fibrosis stage) with improvement of at least 1 grade (D); The effect of pioglitazone in resolution of NASH without worsening of fibrosis (E); The effect of pioglitazone in reduction of at least 2 points in hepatic histologic scores (from two different parameters) (F).
Figure 4
Figure 4
The effect of pioglitazone on weight (A); the effect of pioglitazone on BMI (B); the effect of pioglitazone on total body fat (C); the effect of pioglitazone on HOMA-IR (D); the effect of pioglitazone on fasting plasma glucose (E); the effect of pioglitazone on fasting plasma insulin (F); and the effect of pioglitazone on HbA1c (G).
Figure 5
Figure 5
The effect of pioglitazone in plasma AST (A); the effect of pioglitazone in plasma ALT (B); the effect of pioglitazone in HDL (C); the effect of pioglitazone in LDL (D); and the effect of pioglitazone on triglyceride levels (E).
Figure 6
Figure 6
Effects of pioglitazone on the risk of adverse events in patients with pre-diabetes or T2DM combined with NAFLD (A); Effects of pioglitazone on the risk of discontinuations in patients with pre-diabetes or T2DM combined with NAFLD (B); Effects of pioglitazone on the risk of Serious Adverse Events in patients with pre-diabetes or T2DM combined with NAFLD (C).
Figure 7
Figure 7
Publication bias assessment. (A) Funnel plots for hepatic histologic scores(steatosis grade); (B) Funnel plots for hepatic histologic scores(Inflammation grade); (C) Funnel plots for hepatic histologic scores(ballooning grade); (D) Funnel plots for hepatic histologic scores(fibrosis stage); Funnel plots for resolution of NASH (E); Funnel plots for reduction of at least 2 points in hepatic histologic scores (F).
See this image and copyright information in PMC

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