Related Experiment Video
Updated: Jun 19, 2026

Mouse Model of Metabolic Dysfunction-Associated Steatotic Liver Disease with Fibrosis
Published on: July 18, 2025
Comparative Efficacy of Oral Antidiabetic Drugs on Metabolic Dysfunction-associated Steatotic Liver Disease
Vasileios Petrakis1, Petros Rafailidis1, Anastasia Grapsa2
1Democritus University of Thrace - Alexandropoulis Campus, 2nd University Department of Internal Medicine, University General Hospital Alexandroupolis, Greece, Alexandroupoli.
Background:
Metabolic dysfunction-associated steatotic liver disease is highly prevalent among patients with type 2 diabetes mellitus, exacerbating the risk of severe hepatic and cardiovascular complications. While metformin remains the first-line therapy, the optimal second-line oral antidiabetic drug for mitigating liver disease progression remains unclear.
Patients And Methods:
This retrospective observational study (2019-2023) evaluated 250 patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease (defined by a fatty liver index score of>60) treated at the Outpatient Clinics of the 2nd University Department of Internal Medicine of University General Hospital of Alexandroupolis (Greece). Patients were on baseline metformin and initiated one of four oral antidiabetic drug classes: sodium-glucose cotransporter-2 inhibitors (n = 72), thiazolidinediones (n=36), dipeptidyl peptidase-4 inhibitors (n=77), and sulfonylureas (n=65). The primary end point was metabolic dysfunction-associated steatotic liver disease regression (a fatty liver index score of<30). The secondary end point encompassed severe liver-related outcomes and mortality.
Results:
Sodium-glucose cotransporter-2 inhibitors demonstrated the highest probability of metabolic dysfunction-associated steatotic liver disease regression compared to sulfonylureas (adjusted sub-distribution hazard ratio: 1.99 and 95% confidence interval: 1.75-2.27), dipeptidyl peptidase-4 inhibitors (adjusted sub-distribution hazard ratio: 1.45 and 95% confidence interval: 1.30-1.62), and thiazolidinediones (adjusted sub-distribution hazard ratio: 1.40 and 95% confidence interval: 1.12-1.75). Furthermore, sodium-glucose cotransporter-2 inhibitors significantly reduced the risk of severe liver-related outcomes compared to sulfonylureas (adjusted sub-distribution hazard ratio: 0.37 and 95% confidence interval: 0.17-0.82).
Conclusions:
In patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease, the addition of sodium-glucose cotransporter-2 inhibitors to metformin significantly promotes fatty liver regression and protects against severe liver-related outcomes compared to other standard oral antidiabetic drug classes.
Related Concept Videos
Oral Hypoglycemic Agents: Biguanides and Glitazones
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
Acarbose and miglitol are typically...
Type II Diabetes II: Pathophysiology
Diabetes Mellitus: Type 2 and Gestational
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
Lipid-Lowering Drugs: Statins and Miscellaneous Agents

