Study compares effect of two diabetes drugs in liver disease

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A new study compared the effect of metformin against sulfonylureas in improving long-term outcomes of nonalcoholic fatty liver disease (NAFLD).
Some blood sugar lowering drugs used in type 2 diabetes, such as metformin, are thought to help slow liver damage as they reduce insulin resistance, the root cause of fatty livers.
Researchers from Indiana University School of Medicine, in Indianapolis, US, compared mortality rates and the risk of complications with metformin or sulfonylureas.
They enrolled 458 people diagnosed with NAFLD, of whom 305 had type 2 diabetes, and recorded the number of deaths and events during the following five years.
The results were presented at the recent American Association for the Study of Liver Diseases (AASLD)’s Liver Meeting, in Washington DC.
They revealed that NAFLD patients with type 2 diabetes had a threefold elevated risk of death and more complications from NAFLD than those without diabetes.
However, they found that taking metformin improves survival and lowers the risk of complications related to cirrhosis.
These complications include events of liver decompensation, where metabolic functions diminish, and a common type of liver cancer known as hepatocellular carcinoma.
This held true even after adjusting for HbA1c levels and other factors. Metformin use was also associated with a decreased risk of transplant due to severe liver injury.
In monotherapy, sulfonylureas were found to have opposite effects. The drug was linked to premature death and an increase in liver decompensation.
Statistically, sulfonylureas were associated with a five-fold increase in the risk of death or transplant and twice the risk of liver decompensation.
In light of these findings, researchers recommend reconsidering giving sulfonylureas to patients who have advanced liver complications from NAFLD.
Further research is now needed to confirm these results and elucidate the effects of different diabetes drugs on NAFLD-related outcomes in people with type 2 diabetes.