Ng Cheng Han, Lin Snow Yunni, Chin Yip Han, Lee Ming Hui, Syn Nicholas, Goh Xin Lei, Koh Jin Hean, Quek Jingxuan, Hao Tan Darren Jun, Mok Shao Feng, Tan Eunice, Dan Yock Young, Chew Nicholas, Khoo Chin Meng, Siddiqui Mohammad Shadab, Muthiah Mark
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Endocr Pract. 2022 Feb;28(2):223-230. doi: 10.1016/j.eprac.2021.09.013. Epub 2021 Oct 1.
Type 2 diabetes mellitus and nonalcoholic fatty liver disease (NAFLD) are closely related, and antidiabetic medications have been shown to be potential therapeutics in NAFLD. Using a network meta-analysis, we sought to examine the effectiveness of antidiabetic agents for the treatment of NAFLD in patients with type 2 diabetes mellitus.
Medline and Embase were searched for randomized controlled trials relating to the use of antidiabetic agents, including sodium-glucose transport protein 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists, and peroxisome proliferator-activated receptor gamma (PPARγ) agonists, biguanides, sulfonylureas and insulin, on NAFLD in patients with diabetes. The p-score was used as a surrogate marker of effectiveness.
A total of 14 articles were included in the analysis. PPARγ agonists were ranked as the best treatment in steatosis reduction, resulting in the greatest reduction of steatosis. There was statistical significance between PPARγ agonists [mean difference (MD): -6.02%, confidence interval (CI): -10.37% to -1.67%] and SGLT2 inhibitors (MD: -2.60%, CI: -4.87% to -0.33%) compared with standard of care for steatosis reduction. Compared with PPARγ agonists, SGLT2 inhibitors resulted in a statistical significant reduction in fibrosis (MD: -0.06, CI: -0.10 to -0.02). Body mass index reduction was highest in SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists. Additionally, SGLT2 inhibitors were ranked as the best treatment for increasing high-density lipoprotein and reducing low-density lipoprotein.
Glucagon-like peptide-1 receptor agonists and SGLT2 inhibitors were suitable alternatives for the treatment of NAFLD in those with type 2 diabetes mellitus with a reduction in body mass index, fibrosis, and steatosis. SGLT2 inhibitors also have the added benefit of lipid modulation.
2型糖尿病与非酒精性脂肪性肝病（NAFLD）密切相关，抗糖尿病药物已被证明是NAFLD的潜在治疗方法。我们通过网络荟萃分析，旨在研究抗糖尿病药物对2型糖尿病患者NAFLD的治疗效果。
检索Medline和Embase数据库，查找有关使用抗糖尿病药物（包括钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂、胰高血糖素样肽-1受体激动剂、过氧化物酶体增殖物激活受体γ（PPARγ）激动剂、双胍类、磺脲类和胰岛素）治疗糖尿病患者NAFLD的随机对照试验。p值用作疗效的替代指标。
分析共纳入14篇文章。PPARγ激动剂在减少脂肪变性方面被列为最佳治疗方法，导致脂肪变性减少最多。与脂肪变性减少的标准治疗相比，PPARγ激动剂[平均差（MD）：-6.02%，置信区间（CI）：-10.37%至-1.67%]和SGLT2抑制剂（MD：-2.60%，CI：-4.87%至-0.33%）之间存在统计学意义。与PPARγ激动剂相比，SGLT2抑制剂导致纤维化有统计学意义的降低（MD：-0.06，CI：-0.10至-0.02）。SGLT2抑制剂和胰高血糖素样肽-1受体激动剂的体重指数降低幅度最大。此外，SGLT2抑制剂在升高高密度脂蛋白和降低低密度脂蛋白方面被列为最佳治疗方法。
胰高血糖素样肽-1受体激动剂和SGLT2抑制剂是治疗2型糖尿病合并NAFLD患者的合适替代药物，可降低体重指数、纤维化和脂肪变性。SGLT2抑制剂还具有调节血脂的额外益处。
