title: Effect of incretin therapies compared to pioglitazone and gliclazide in non-alcoholic fatty liver disease in diabetic patients not controlled on metformin alone: An observational, pilot study.
abstract: OBJECTIVE
  To compare the effect of different hypoglycemic drugs on laboratory and ultrasonographic markers of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes not controlled on metformin alone.
  
  
  METHODS
  Prospective study of diabetic patients treated with metformin in combination with gliclazide, pioglitazone, sitagliptin, exenatide, or liraglutide. NAFLD was assessed by abdominal ultrasound and NAFLD fibrosis score was calculated at baseline and 6 months.
  
  
  RESULTS
  Fifty-eight patients completed 6 months of follow-up: 15 received gliclazide, 13 pioglitazone, 15 sitagliptin, 7 exenatide, and 8 liraglutide. NAFLD affected 57.8% of patients at baseline, and its ultrasonographic course varied depending on changes in weight (P=.009) and waist circumference (P=.012). The proportions of patients who experienced ultrasonographic improvement in the different treatment groups were: 33.3% with gliclazide, 37.5% with pioglitazone, 45.5% with sitagliptin, 80% with exenatide, and 33% with liraglutide (P=.28).
  
  
  CONCLUSIONS
  Qualitative ultrasonographic NAFLD improvement in diabetic patients treated with metformin in combination with other hypoglycemic drugs is associated to change over time in weight and waist circumference. Long-term clinical trials are needed to assess whether incretin therapies result in better liver outcomes than other hypoglycemic therapies.
authors.affiliation: Unidad de Endocrinología, Hospital Dr. José Molina Orosa, Lanzarote, Canarias, España. Electronic address: eduardogd@terra.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: García Díaz
authors.affiliation: Unidad de Gastroenterología, Hospital Vall d'Hebron, Barcelona, España.
authors.forename: Danila
authors.initials: D
authors.lastname: Guagnozzi
authors.affiliation: Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, Canarias, España.
authors.forename: Verónica
authors.initials: V
authors.lastname: Gutiérrez
authors.affiliation: Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, Canarias, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mendoza
authors.affiliation: Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, Canarias, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Maza
authors.affiliation: Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, Canarias, España.
authors.forename: Yulene
authors.initials: Y
authors.lastname: Larrañaga
authors.affiliation: Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, Canarias, España.
authors.forename: Dolores
authors.initials: D
authors.lastname: Perdomo
authors.affiliation: Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, Canarias, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Godoy
authors.affiliation: Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, Canarias, España.
authors.forename: Ghalli
authors.initials: G
authors.lastname: Taleb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D000077270:Exenatide; D005260:Female; D005907:Gliclazide / Q000008:administration & dosage / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D054795:Incretins / Q000008:administration & dosage / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D000069450:Liraglutide / Q000008:administration & dosage / Q000627:therapeutic use*; D008111:Liver Function Tests; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D010455:Peptides / Q000008:administration & dosage / Q000627:therapeutic use*; D010865:Pilot Projects; D000077205:Pioglitazone; D011446:Prospective Studies; D000068900:Sitagliptin Phosphate / Q000008:administration & dosage / Q000627:therapeutic use*; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000627:therapeutic use*; D014688:Venoms / Q000008:administration & dosage / Q000627:therapeutic use*; D055105:Waist Circumference / Q000187:drug effects
chemical_list: D000077270:Exenatide; D005907:Gliclazide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D054795:Incretins; D008055:Lipids; D000069450:Liraglutide; D008687:Metformin; D010455:Peptides; D000077205:Pioglitazone; D000068900:Sitagliptin Phosphate; D045162:Thiazolidinediones; D014688:Venoms
keywords: Esteatosis hepática no alcohólica; GLP-1; Glucagon-like peptide-1; Non-alcoholic fatty liver disease; Thiazolidinediones; Tiazolidindionas