| [ Summary ] |
The relationship between type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) is like the two sides of a coin, and the treatment for diabetes strongly affects NAFLD pathological condition. There are three major kinds of antidiabetics : insulin sensitizer (metformin and pioglitazone), insulin secretagogues (sulfonylureas, DDP‒4 inhibitors, and GLP‒1 receptor agonists), and glucose absorption/excretion regulators [alpha‒glucosidase inhibitors (alpha GI) and SGLT2 inhibitors]. Sulfonylureas and insulin itself have been associated with NAFLD progression and HCC occurrence ; therefore, these are not used as first‒line agents. Metformin is recommended as a first‒line therapy for diabetes in the US, but histological improvement in NAFLD following such treatment has not yet been established. Pioglitazone and GLP‒1 receptor agonists have been reported to histologically improve NAFLD, but the former cause obesity and the latter are injection drugs. The effects by DDP‒4 inhibitors or alpha‒GI are uncertain. SGLT2 inhibitors might be promising because they ameliorate liver function without histological evidence. Therefore, antidiabetics should be selected according to NAFLD clinical features in each case. |