改善 2 型糖尿病患者的血糖控制对 NAFLD 有有益影响，与 BMI 变化或降血糖药物无关。
Improved glycaemic control in patients with type 2 diabetes has a beneficial impact on NAFLD, independent of change in BMI or glucose lowering agent.
机构信息
School of Nutrition Science, University of Milan, Milan, Italy; Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK.
Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK.
出版信息
Nutr Metab Cardiovasc Dis. 2023 Mar;33(3):640-648. doi: 10.1016/j.numecd.2022.12.010. Epub 2022 Dec 21.
BACKGROUND AND AIM
The current focus of the treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) is lifestyle intervention with the aim of significant weight loss alongside aggressive cardiovascular risk reduction. NAFLD is tightly associated with type 2 diabetes (T2D) and obesity. In patients with T2D, glucose lowering agents that promote weight loss have shown a beneficial impact on NAFLD. However, it remains unclear as to whether glucose lowering can improve NALFD in patients with T2D, independent of weight loss.
METHODS AND RESULTS
In a retrospective analysis of data from 637 people with T2D, we examined the longitudinal impact of optimizing glycaemic control with DPP-IV inhibitors, GLP-1RAs and SGLT2 inhibitors on Fatty liver index (FLI) and Fibrosis score 4 (Fib-4) adjusting for changes in BMI and choice of glucose lowering regimen over a 12-month period. Multiple linear regression analysis demonstrated a significant correlation between the change in glycated haemoglobin and change in FLI after adjustment for change in BMI, age, sex, and drug class (R = 0.467, p = 0.031). The greatest reduction in FLI was observed in patients with the largest reduction in glycated haemoglobin (p < 0.0001). The probability of improvements in FLI with optimization of glycaemic control was similar with all 3 glucose lowering agents, despite differences in weight reduction. Similar relationships were observed examining the changes in glycaemic control and Fib-4.
CONCLUSIONS
Improvements in glucose control that are independent of weight loss are associated with improvement in NAFLD and should form an integral part of the management patients with co-existent NAFLD and T2D.
背景与目的
目前，非酒精性脂肪性肝病（NAFLD）的治疗重点是生活方式干预，目标是在积极降低心血管风险的同时显著减轻体重。NAFLD 与 2 型糖尿病（T2D）和肥胖密切相关。在 T2D 患者中，具有减重作用的降糖药物已显示出对 NAFLD 的有益影响。然而，尚不清楚降糖是否可以在不减轻体重的情况下改善 T2D 患者的 NAFLD。
方法和结果
我们对 637 例 T2D 患者的数据进行了回顾性分析，考察了在 12 个月的时间内，通过 DPP-IV 抑制剂、GLP-1RA 和 SGLT2 抑制剂优化血糖控制对 Fatty liver index（FLI）和 Fibrosis score 4（Fib-4）的纵向影响，同时调整 BMI 的变化和降糖方案的选择。多元线性回归分析显示，在调整 BMI、年龄、性别和药物种类的变化后，糖化血红蛋白的变化与 FLI 的变化之间存在显著相关性（R=0.467，p=0.031）。在糖化血红蛋白降幅最大的患者中，FLI 的降幅最大（p<0.0001）。尽管降糖药物的减重效果不同，但通过优化血糖控制改善 FLI 的概率与所有 3 种降糖药物相似。观察到血糖控制变化与 Fib-4 之间也存在类似的关系。
结论
与体重减轻无关的血糖控制改善与 NAFLD 的改善相关，应成为合并 NAFLD 和 T2D 患者管理的重要组成部分。
Zotero 插件