Abstract
: Background: Diabetes is associated with conditions such as obesity, metabolic syndrome, and fatty liver disease. Utilizing medications that can simultaneously treat diabetes and its related conditions could be highly beneficial for patients. Objectives: This clinical trial aimed to investigate the effect of empagliflozin in combination with pioglitazone on the improvement of fatty liver disease in patients with type 2 diabetes. Methods: Patients were divided into two groups: One received only pioglitazone (n = 42), and the other received both pioglitazone and empagliflozin (n = 43) for 24 weeks. Liver indices were examined at the beginning of the study and again 24 weeks after the intervention began, using serology and ultrasound methods. Results: Both treatments improved the indicators of fatty liver disease, including fasting blood sugar (FBS), hemoglobin A1c (HbA1c), cholesterol, triglycerides, low-density lipoprotein (LDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), non-alcoholic fatty liver disease (NAFLD) activity score, with the exception of aspartate-to-platelet ratio index (APRI) and the fibrosis-4 (Fib-4) index. However, no significant difference was observed in the changes of these indices between the two types of treatment, except for high-density lipoprotein (HDL) and NAFLD. Conclusions: It appears that both pioglitazone alone and pioglitazone combined with empagliflozin improve fatty liver disease in patients with type 2 diabetes. However, the effects of these two treatment regimens were not found to be superior to each other.