Pharmacotherapy for Non-alcoholic Fatty Liver Disease Associated with Diabetes Mellitus Type 2

Abstract

Non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2 commonly coexist as a manifestation of metabolic syndrome. The presence of diabetes promotes the progression of simple fatty liver to non-alcoholic steatohepatitis (NASH) and cirrhosis, and the presence of NAFLD increases the risk of diabetic complications. This coexistence affects a large part of the population, imposing a great burden on health care systems worldwide. Apart from diet modification and exercise, recent advances in the pharmacotherapy of diabetes offer new prospects regarding liver steatosis and steatohepatitis improvement, enriching the existing algorithm and supporting a multifaceted approach to diabetic patients with fatty liver disease. These agents mainly include members of the families of glucagon-like peptide-1 analogues and the sodium-glucose co-transporter-2 inhibitors. In addition, agents acting on more than one receptor simultaneously are presently under study, in an attempt to further enhance our available options.

Keywords: Diabetes mellitus type 2; GLP1; NAFLD/NASH; SGLT2; Steatosis.

Fig. 1. Examples of possible mechanisms of NAFLD amelioration through current antidiabetic treatment.-

AMPK, AMP-activated protein kinase; ER, endoplasmic reticulum; FAO, fatty acid oxidation; HSL, hormone-sensitive lipase; IL-6, interleukin-6; MCP-1, monocyte chemoattractant protein-1; TG, triglycerides; TNF-α, tumor necrosis factor-alpha.