Effect of insulin versus triple oral therapy on the progression of hepatic steatosis in type 2 diabetes.
BACKGROUND
Hyperinsulinemia has been associated with hepatic fat deposition and ensuing insulin resistance. It is unknown if treatment with exogenous insulin in patients with type 2 diabetes, who are most prone to hepatic fat accumulation, would promote the occurrence or worsening of nonalcoholic fatty liver disease.


METHODS
Patients with treatment-naive type 2 diabetes (N = 16) were treated with insulin and metformin for a 3-month lead-in period, then assigned triple oral therapy (metformin, glyburide, and pioglitazone) or continued treatment with insulin and metformin. Hepatic triglyceride content (HTC)-measured by magnetic resonance spectroscopy, serum lipids, glucose, liver function tests, and inflammatory and thrombotic biomarkers were followed for a median of 31 months.


RESULTS
The 45% decline in HTC during the lead-in period persisted through the follow-up period with no difference between treatment groups at the end of the study (5.26 ± 4.21% in the triple oral therapy vs 7.47 ± 7.40% for insulin/metformin), whereas glycemic control was comparable.


CONCLUSIONS
Improvements in HTC with initial insulin/metformin therapy persisted through the median 31-month follow-up period regardless of the treatment. More importantly, insulin-based treatment did not appear to promote or worsen nonalcoholic fatty liver disease.
Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX 75390-8857, USA. ildiko.lingvay@utsouthwestern.edu
Ildiko
I
Lingvay
Erin D
ED
Roe
Jonathan
J
Duong
David
D
Leonard
Lidia S
LS
Szczepaniak
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005905:Glyburide / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D008297:Male; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D000077205:Pioglitazone; D045162:Thiazolidinediones / Q000494:pharmacology / Q000627:therapeutic use; D014280:Triglycerides / Q000378:metabolism; D055815:Young Adult
D007004:Hypoglycemic Agents; D007328:Insulin; D045162:Thiazolidinediones; D014280:Triglycerides; D008687:Metformin; D005905:Glyburide; D000077205:Pioglitazone