Evaluating Pioglitazone for Managing Type 2 Diabetes Mellitus in Patients with Nonalcoholic Fatty Liver Disease

Among liver disorders, nonalcoholic fatty liver disease (NAFLD) is the most common and is associated with metabolic syndromes, particularly type 2 diabetes mellitus (T2DM). This study aimed to assess the effectiveness of pioglitazone in the management of T2DM with NAFLD.

This retrospective, single-center, observational study was carried out at Dr Panikar's Speciality Care Centre from 1^st September 2022 to 1^st February 2024. The data were collected from the medical records of diabetic patients with NAFLD who received pioglitazone. Patients aged between 18 and 80 years who had diabetes along with NAFLD were included in the study.

A total of 3,350 patients were enrolled in this study, of whom 2,074 were male, with a mean age of 48.6 years. The mean estimated A1C (eA1C) showed a significant reduction at 6 months compared to baseline (6.87 vs 7.6%; mean difference (95% CI): 0.50% (0.39, 0.61); p < 0.001). At baseline, the mean controlled attenuation parameter (CAP) was significantly higher than at 6 months (p = 0.032). Similarly, the mean cholesterol level was significantly higher at baseline compared to 6 months (p = 0.020). A 25.7% decrease in grade 3 fatty liver was noted over the 6-month period from baseline. In terms of the decrease in fibrosis severity, a 37.5% reduction in F2, a 25.8% reduction in F1, and a 17.6% reduction in F4 were observed from baseline to 6 months.

In T2DM patients with NAFLD, pioglitazone improves glycemic control and reduces both fatty liver grades and fibrosis stages.