Commentary
The goal of K. Cusi et al. (Division of Endocrinology, Diabetes and Metabolism, University of Florida, USA) was to review evidence about the complex association between NAFLD and T2DM, and highlight the potential for disease co-management with the available medications used for the treatment of diabetes.
Metabolic factors contribute to the pathogenesis and co-existence of NAFLD with T2DM. The presence of T2DM in patients with NAFLD increases the risk of disease progression to steatohepatitis (NASH) and advanced fibrosis, cirrhosis, and even hepatocellular carcinoma. In addition to lifestyle modification, pioglitazone and glucagon-like peptide 1 receptor agonists (GLP-1RAs) both reduce the high cardiovascular risk and improve liver histology in patients with NAFLD. The impact of SGLT-2 inhibitors on liver histology has not been fully established. Metformin, DPP-4 inhibitors, and insulin appear to have modest to no effect on modifying the natural history of NAFLD.
The presence of NASH in a patient with T2DM should call for taking advantage of antidiabetic medications with proven efficacy to improve cardiometabolic health and prevent liver disease progression.
