Empagliflozin May Reduce Liver Fat Content in Patients With Type 2 Diabetes

SAN FRANCISCO — Treatment with empagliflozin, a sodium-glucose transporter 2 inhibitor, may reduce liver fat content and increase serum adiponectin in patients with well-controlled type 2 diabetes, according to study results presented at the American Diabetes Association 79th Scientific Sessions, held June 7 to 11, 2019.

Nonalcoholic fatty liver disease (NAFLD) contributes to insulin resistance and increased cardiovascular risk in patients with type 2 diabetes. As there is no recommended therapy for NAFLD in these patients, the goal of this study was to assess the effect of empagliflozin on liver fat content in patients with metabolically well-controlled diabetes of short duration.

The study cohort included 84 patients with type 2 diabetes (mean age, 63 years; mean body mass index, 32.2 ± 4.5 kg/m²; mean hemoglobin A1c, 6.6% ± 0.5%; disease duration, 38 ± 27 months). The patients were randomly assigned to treatment with empagliflozin 25 mg once daily or placebo. The primary outcome was liver fat content measured by ¹H-magnetic resonance spectroscopy (STEAM) and fat-selective magnetic resonance imaging (IDEAL).

With empagliflozin, there was a 33% reduction in liver fat content (95% CI, -43% to -23%; P <.0001) compared with a 14% reduction with placebo (95% CI, -23% to -3%; P =.014) with a statistically significant difference between the 2 groups (P =.007).

Empagliflozin was associated with decreased body weight (least square means, -2.7 ± 0.4 kg; P <.0001), while in the placebo group there was no weight change. Statistical analysis revealed the reduction in liver fat content was mainly secondary to weight loss.

While serum adiponectin levels increased only in the group of patients receiving empagliflozin (P <.0001), there was no correlation between the change in adiponectin levels with changes in liver fat content or body weight. There was an inverse correlation between changes in serum adiponectin levels and serum cytokeratin-18 M30 fragment only in the group receiving empagliflozin treatment (P =.014).

“[E]mpagliflozin effectively reduces [liver fat content] in well-controlled [patients with type 2 diabetes] and increases serum adiponectin with beneficial effects on hepatocellular integrity. Thus, empagliflozin may improve NAFLD via distinct different mechanisms,” concluded the researchers.

Disclosures: Multiple authors disclosed associations with the pharmaceutical industry. Please see the original abstract for a full list of authors’ disclosures.

Reference

Kahl S, Gancheva S, Strassburger K, et al. Effect of empagliflozin on liver fat content in type 2 diabetes: the EMLIFA001 trial. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco, CA. Oral Presentation 133-OR.