Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease: A Systematic Review of Randomized Controlled Trials.

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity in individuals with type 2 diabetes mellitus (T2DM), contributing to increased liver-related complications and cardiovascular risk. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as potential treatments offering benefits for both metabolic and liver-related outcomes. This systematic review evaluated the efficacy of SGLT2 inhibitors in improving hepatic steatosis, liver enzymes, glycemic control, and liver histology in patients with T2DM and NAFLD. The review was conducted using a structured methodology, including systematic database searches and risk of bias assessments. Included randomized controlled trials (RCTs) investigated various SGLT2 inhibitors, such as dapagliflozin, empagliflozin, ertugliflozin, and ipragliflozin. Most studies showed significant reductions in liver fat content, improvements in serum liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT)), and favorable effects on blood pressure, triglycerides, and body composition. Glycemic control markers, including glycated hemoglobin (HbA1c), fasting glucose, and insulin resistance indices, also improved. One biopsy-based study demonstrated histological improvements, including reduced fibrosis and resolution of nonalcoholic steatohepatitis (NASH). No serious adverse events were reported. These findings suggest SGLT2 inhibitors may offer dual benefits for managing both diabetes and fatty liver disease. Further long-term studies focusing on liver histology as a primary endpoint are needed to confirm these effects.