Liraglutide, Metformin, and Gliclazide Compared in Comorbid Type 2 Diabetes and Nonalcoholic Fatty Liver Disease

In a cohort of patients with type 2 diabetes (T2D) with nonalcoholic fatty liver disease (NAFLD), treatment with liraglutide, metformin, or gliclazide reduced hemoglobin A1c (HbA1c) levels and intrahepatic fat content (IHF), according to recent findings published in the Journal of Diabetes. However, several significant between-group differences were observed as well.

Researchers of the prospective, single-center, open-label, randomized study enrolled 87 patients with T2D and NAFLD. Patients were randomly assigned to 24-week treatment with liraglutide, metformin, or gliclazide (n=29 per treatment regimen).

At baseline, clinical characteristics, glucose levels, IHF content, and lipid profiles were comparable between groups.

HbA1c levels, IHF content, and liver function were the primary outcome measures.

Results demonstrated that all 3 treatments reduced HbA1c levels (P for all <.001) and IHF content (P for all <.001). According to between-group analyses, when compared with gliclazide, liraglutide (P =.002) and metformin (P =.014) yielded higher reductions in HbA1c levels, and liraglutide demonstrated greater decreases in IHF content (P =.001).

Furthermore, both liraglutide and metformin led to reductions in weight and improvements in liver function.

In other data, researchers reported positive correlations between changes in IHF content and reductions in weight and levels of serum alanine aminotransferase and triglycerides. There were also greater IHF content reductions in patients with weight loss ≥5%, waistline changes ≤0 cm (including decreases in waistline), HbA1c reductions ≥2.5%, and HbA1c levels <6.5%.

Study limitations of note, according to the researchers, were the small sample size and the inability to use proton magnetic resonance spectroscopy, considered the gold standard for evaluating IHF, because of budgetary constraints.

Despite these limitations, the researchers concluded, “[L]iraglutide and metformin monotherapy ameliorated liver aminotransferase levels, alleviated hyperglycemia, and reduced IHF, body weight, and waistline to a greater extent than gliclazide in patients with [T2D and] NAFLD. The liraglutide group had slightly better results than the metformin group. Reductions in IHF were associated with greater weight loss, no increase in waistline, and lower HbA1c.”

Reference

Feng W, Gao C, Bi Y, et al. Randomized trial comparing the effects of gliclazide, liraglutide, and metformin on diabetes with non-alcoholic fatty liver disease [published online May 29, 2017]. J Diabetes. doi:10.1111/1753-0407.12555