The determination of the comparative effect of Ertugliflozin, Pioglitazone, and Metformin on patients of non-alcoholic fatty liver disease in type 2 diabetes mellitus.

Abstract

Abstract Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases and malignancies. With the increased prevalence rate of NAFLD worldwide, an effective therapeutic solution for such a condition is essential. Among the previous studies pioglitazone, metformin, and sodium-glucose transporter 2 inhibitors were established as role models for the improvement of NAFLD. Objective: The study aimed to evaluate the effect and safety of pioglitazone, ertugliflozin, and metformin in NAFLD with type 2 diabetes mellitus (T2DM) and their effect on the function of liver enzymes. Materials and methods: This study was prospectively randomized. A total of 180 patients having NAFLD with T2DM were divided into three groups administered with ertugliflozin 15mg (n = 60), pioglitazone 30 mg (n = 60), and metformin 500 mg (n = 60) for 24 weeks. Liver stiffness (LS) and controlled attenuation parameters were measured using fibroscan. The grades of fatty liver were identified ultrasonically. Results: The result suggested that the ratio of fatty liver in grade 1 (mild fat content) was increased significantly in the ertugliflozin group (0.0 to 11.6%) while in the pioglitazone group (10.0 to 8.3%), a minor decrease was observed in grade 3 (severe far content). A significant decrease was observed in LSM (7.94±3.23 to 6.5±3.0) among the ertugliflozin group. The CAP score was significantly decreased from (360.38±39.34 to 300.60±37.0). The level of biochemical parameters including ALT, AST, and GGT significantly decreased in the ertugliflozin group. There was also a significant decrease in blood sugar, lipid profile, and body mass index between the groups. Previous studies analysis declare BMI is the risk factor for fatty liver which was also decreased in this study. Conclusion: ertugliflozin has significantly improved fatty liver, liver stiffness, and liver enzymes of patients having NAFLD with T2DM. The therapy was safe and effective and it may be used in future recommendations for physician facilitation in the case of NAFLD patients.