Effect of Empagliflozin on Liver Fat in Patients With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease: A Randomized Controlled Trial (E LIFT Trial)
OBJECTIVE Sodium glucose cotransporter 2 (SGLT 2) inhibitors have been shown to reduce liver fat in rodent models. Data regarding the effect of SGLT 2 inhibitors on human liver fat are scarce. This study examined the effect of empagliflozin (an SGLT 2 inhibitor) on liver fat in patients with type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) by using MRI derived proton density fat fraction (MRI PDFF) RESEARCH DESIGN AND METHODS Fifty patients with type 2 diabetes and NAFLD were randomly assigned to either the empagliflozin group (standard treatment for type 2 diabetes plus empagliflozin 10 mg daily) or the control group (standard treatment without empagliflozin) for 20 weeks. Change in liver fat was measured by MRI PDFF. Secondary outcome measures were change in alanine transaminase (ALT) aspartate transaminase (AST) and g glutamyl transferase (GGT) levels. RESULTS When included in the standard treatment for type 2 diabetes, empagliflozin was significantly better at reducing liver fat (mean MRI PDFF difference between the empagliflozin and control groups 4.0% P 0.0001) Compared with baseline, significant reduction was found in the end of treatment MRI PDFF for the empagliflozin group (16.2% to 11.3% P 0.0001) and a nonsignificant change was found in the control group (16.4% to 15.5% P 0.057) The two groups showed a significant difference for change in serum ALT level (P 0.005) and nonsignificant differences for AST (P 0.212) and GGT (P 0.057) levels. CONCLUSIONS When included in the standard treatment for type 2 diabetes, empagliflozin reduces liver fat and improves ALT levels in patients with type 2 diabetes and NAFLD.
Diabetes Care