Assessment of insulin resistance and effect of metformin in nonalcoholic steatohepatitis--a preliminary report.
BACKGROUND
Insulin resistance plays a major role in the pathogenesis of nonalcoholic steatohepatitis (NASH). Insulin-sensitizing drugs like metformin may have a role in the treatment of this disease.


OBJECTIVE
To determine insulin resistance and the role of metformin in the treatment of NASH.


METHODS
We prospectively studied 25 patients with NASH over a period of one and a half years. In addition to clinicopathological profile, we studied the insulin resistance by insulin tolerance test in 10 of them; seven of them, who did not respond to 3 months of low-calorie, low-fat diet, exercise, weight reduction and ursodeoxycholic acid (UDCA), were treated with metformin for six months. Results were compared with control groups.


RESULTS
All 10 patients with NASH tested had low insulin sensitivity; there was significant difference in the rate constant for insulin sensitivity (Kitt) between patients with NASH and normal volunteers. Thirteen (52%) patients responded to dietary restriction, exercise, weight reduction and UDCA. Four of 7 patients treated with metformin had normalization of ALT.


CONCLUSIONS
Patients with NASH have insulin resistance. Metformin may have a role in the treatment of these patients.
Duseja
Ajay
A
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012.
Murlidharan
R
R
Bhansali
A
A
Sharma
Sunil
S
Das
Ashim
A
Das
Reena
R
Chawla
Yogesh
Y
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D005260:Female; D006505:Hepatitis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance; D008099:Liver / Q000473:pathology; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged
D007004:Hypoglycemic Agents; D008687:Metformin; D000410:Alanine Transaminase