Background Increasing evidence suggests that some antidiabetic medications may improve markers of abnormal liver structure and function in people with non-alcoholic fatty liver disease. We investigated this association in older people with type 2 diabetes.
Methods 474 participants, aged 63–79 years, from the Edinburgh Type 2 Diabetes Study, a large, randomly-selected population of patients with Type 2 diabetes, underwent assessment on two occasions. At baseline, liver ultrasonography was undertaken and antidiabetic medications (metformin, sulphonyureas and thiazolidinediones) were recorded. Liver ultrasonography was repeated approximately 3 years later. Hepatosteatosis was graded as either normal or “fatty”, and the change between examinations as regression, no change or progression. χ2 for trend was used to analyse the association.
Results Mean follow-up was 2.7 years. 9.5% (n=45) of participants progressed, 13.9% (n=66) regressed and 76.6% (n=363) remained the same. Thiazolidinedione use was significantly higher among participants whose hepatosteatosis regressed (5.0%, 11% and 19.7% in participants with progression, no change and regression respectively, p=0.02). Similar figures for metformin use were 55.0%, 67.0% and 67.2% respectively (p=0.28) and for sulphonyurea use were 15.0%, 34.9% and 31.1% respectively (p=0.19).
Conclusion In a large sample of patients with type 2 diabetes representative of patients with type 2 diabetes in general, thiazolidinedione use was associated with regression of hepatosteatosis. This is consistent with emerging evidence from clinical trials suggesting that there may be a role for thiazolidinediones beyond glucose control in patients with type 2 diabetes. Further analyses are warranted to explore the potential mechanism underlying this association.
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