Effect of Empagliflozin On Liver Enzymes of Patients In Non-Alcoholic Steatohepatitis In Type 2 Diabetes Mellitus
DOI:
https://doi.org/10.37762/jgmds.10-2.375Keywords:
Empagliflozin, Type 2 diabetes mellitus, Alanine Transaminase, Non-alcoholic Fatty Liver disease, Non-alcoholic steatohepatitisAbstract
OBJECTIVES
To assess the effect of 10 mg and 25 mg once daily Empagliflozin on liver enzymes of patients of non-alcoholic steatohepatitis in patients of type 2 diabetes mellitus (T2DM).
METHODOLOGY
The study design was Quasi Experimental. Thirty three adult patients of Type 2 diabetes mellitus (T2DM) who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycemic control (HBA1C > 7% <12%), had elevated Alanine Transaminase (ALT) levels and had ultrasonographic features consistent with non-alcoholic fatty liver disease (NAFLD) were divided into three groups, one group receiving 10 mg Empagliglozin as add-on treatment (Group A), the second group receiving 25 mg of Empagliflozin (Group B) as an additional treatment, and the third group continued with previous medications without any additional treatment (Group C). HbA1C levels and ALT levels of all the three groups were taken at baseline and at 12 weeks.
RESULTS
Total patients and their mean ages in group A, B and C were 10, 12 and 11 and 52.40 ±4.24 years, 52.42 ± 5.27 years and 52.34 ± 4.37 years, respectively. There was a statistically significant (p > 0.05) decrease mean ALT levels in Group A pre-treatment and 12 weeks post-treatment. Similarly, there was a statistically significant (p > 0.05) decrease mean ALT levels in Group B pre-treatment and 12 weeks post-treatment.
CONCLUSION
Empagliflozin in both 10mg and 25 mg once daily doses cause statistically significant reduction in ALT levels in patients with NASH associated with T2DM
Downloads
Metrics
References
Younossi ZM, Golabi P, de Avila L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol. 2019 Oct;71(4):793-801
Tanase DM, Gosav EM, Costea CF, Ciocoiu M, Lacatusu CM, Maranduca MA, Ouatu A, Floria M. The Intricate Relationship between Type 2 Diabetes Mellitus (T2DM), Insulin Resistance (IR), and Non-alcoholic Fatty Liver Disease (NAFLD). J Diabetes Res. 2020 Jul 31;2020:3920196
Dai W, Ye L, Liu A, et al. Prevalence of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis. Medicine (Baltimore) 2017; 96:e8179
Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. BMJ. 2014;349:g4596
Longo M, Zatterale F, Naderi J, et al. Adipose Tissue Dysfunction as Determinant of Obesity-Associated Metabolic Complications. Int J Mol Sci. 2019 May 13;20(9):2358
Kwon SS, Lee SG. A high alanine aminotransferase/aspartate aminotransferase ratio determines insulin resistance and metabolically healthy/unhealthy obesity in a general adult population in Korea: the Korean National Health and nutritional examination survey 2007-2010. Exp Clin Endocrinol Diabetes. 2019;127:677–84
Mandal A, Bhattarai B, Kafle P, et al. Elevated Liver Enzymes in Patients with Type 2 Diabetes Mellitus and Non-alcoholic Fatty Liver Disease. Cureus. 2018 Nov 23;10(11):e3626
Ahamed F, Karim MR, Haque MA, Rashid MH, et al. Study on Alanine Aminotransferase in Patients of Type 2 Diabetes Mellitus. Mymensingh Med J. 2021 Apr;30(2):343-350.
West J, Brousil J, Gazis A, et al. Elevated serum alanine transaminase in patients with type 1 or type 2 diabetes mellitus. QJM. 2006;99:871–876
Kotronen A, Juurinen L, Hakkarainen A, et al. Liver fat is increased in type 2 diabetic patients and underestimated by serum alanine aminotransferase compared with equally obese nondiabetic subjects. Diabetes Care. 2008;31:165–169
American Diabetes Association Comprehensive medical evaluation and assessment of comorbidities. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022;45(Suppl. 1):S46–S59
Bril F, Cusi K. Management of non-alcoholic fatty liver disease in patients with type 2 diabetes: a call to action. Diabetes Care. 2017;40:419–430
Semmler G, Datz C, Reiberger T, Trauner M. Diet and exercise in NAFLD/NASH: Beyond the obvious. Liver Int. 2021 Oct;41(10):2249-2268
Shankar S.S., Shankar R.R., Railkar R.A., Beals C.R., Steinberg H.O., Kelley D.E. Early clinical detection of pharmacologic response in insulin action in a nondiabetic insulin-resistant population. Curr Ther Res Clin Exp. 2015;77:83–89
Shaaban HH, Alzaim I, El-Mallah A, et al. Metformin, pioglitazone, dapagliflozin and their combinations ameliorate manifestations associated with NAFLD in rats via anti-inflammatory, anti-fibrotic, anti-oxidant and anti-apoptotic mechanisms. Life Sci. 2022 Nov 1;308:120956.
Kothari S, Dhami-Shah H, Shah SR. Antidiabetic Drugs and Statins in Non-alcoholic Fatty Liver Disease. J Clin Exp Hepatol. 2019 Nov-Dec;9(6):723-730.
Ji J, Feng M, Huang Y, Niu X. Liraglutide inhibits receptor for advanced glycation end products (RAGE)/reduced form of nicotinamide-adenine dinucleotide phosphate (NAPDH) signaling to ameliorate non-alcoholic fatty liver disease (NAFLD) in vivo and vitro. Bioengineered. 2022 Mar;13(3):5091-5102
Pereira MJ, Eriksson JW. Emerging Role of SGLT-2 Inhibitors for the Treatment of Obesity. Drugs. 2019 Feb;79(3):219-230.
Seino Y, Yabe D, Sasaki T, Fukatsu A, Imazeki H, Ochiai H, Sakai S. Sodium-glucose cotransporter-2 inhibitor luseogliflozin added to glucagon-like peptide 1 receptor agonist liraglutide improves glycemic control with bodyweight and fat mass reductions in Japanese patients with type 2 diabetes: A 52-week, open-label, single-arm study. J Diabetes Investig. 2018 Mar;9(2):332-340
Tobita H, Sato S, Miyake T, Ishihara S, Kinoshita Y. Effects of dapagliflozin on body composition and liver tests in patients with non-alcoholic steatohepatitis associated with type 2 diabetes mellitus: a prospective, open-label, uncontrolled study. Curr Ther Res Clin Exp. 2017;87:13–19
Sattar N, Fitchett D, Hantel S, George JT, Zinman B. Empagliflozin is associated with improvements in liver enzymes potentially consistent with reductions in liver fat: results fromrandomized trials including the EMPA-REG OUTCOME® trial. Diabetologia. 2018;61(10):2155-2163
Chehrehgosha H, Sohrabi MR, Ismail-Beigi F, et al. Empagliflozin Improves Liver Steatosis and Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Diabetes Ther. 2021;12(3):843-861
Poonawala A, Nair SP, Thuluvath PJ. Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case– control study. Hepatology. 2000;32(4):689–692
Kuchay MS, Krishan S, Mishra SK, Farooqui KJ, Singh MK, Wasir JS, Bansal B, et al. Effect of empagliflozin on liver fat in patients with type 2 diabetes and non-alcoholic fatty liver disease: a randomized controlled trial (E-LIIFT trial) Diabetes Care. 2018;41(8):1801–1808
Kusunoki M, Natsume Y, Miyata T, Tsutsumi K, Oshida Y. Effects of concomitant administration of a dipeptidyl peptidase-4 inhibitor in Japanese patients with type 2 diabetes showing relatively good glycemic control under treatment with a sodium glucose co-transporter 2 inhibitor. Drug Res. 2018;68(12):704–709.
Taylor R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause. Diabetologia. 2008;51:1781–1789.
Wild SH, Walker JJ, Morling JR, et al. Cardiovascular disease, cancer, and mortality among people with type 2 diabetes and alcoholic or non-alcoholic fatty liver disease hospital admission. Diabetes Care. 2018;41:341–347
Taheri H, Malek M, Ismail-Beigi F, et al. Effect of Empagliflozin on Liver Steatosis and Fibrosis in Patients With Non-Alcoholic Fatty Liver Disease Without Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial. Adv Ther. 2020;37(11):4697-4708
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Nauman Wazir, Shafqat Ur Rehman, Muhammad Arshad, Muhammad Zubair Wazir, Shehriyar Khan, Muhammad Saqib Ullah
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.