Nonalcoholic fatty liver disease (NAFLD) is the most prevalent cause of chronic liver disease globally, often linked with type 2 diabetes mellitus (T2DM). Affecting up to 30% of the general population and as much as 70% of those with T2DM, NAFLD is a multifaceted disorder characterised by metabolic dysfunction, including obesity, insulin resistance, and hyperlipidaemia. Left unmanaged, NAFLD can progress to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatic carcinoma. A multidisciplinary approach is critical for the effective management of these conditions.
Recent studies have highlighted the potential of sodium-glucose cotransporter 2 (SGLT2) inhibitors, especially ertugliflozin, in improving outcomes for patients with NAFLD and T2DM. Initially developed to regulate blood glucose levels in diabetic patients, SGLT2 inhibitors have demonstrated broader benefits. They improve cardiovascular and renal outcomes, reduce liver fat, and enhance insulin sensitivity.
Ertugliflozin, a novel SGLT2 inhibitor, has shown promising results in lowering HbA1c levels, reducing body weight, and improving liver enzyme profiles, including ALT, AST, and γ-GGT. Studies revealed that patients treated with ertugliflozin experienced significant reductions in hepatic fat grades, alongside improvements in insulin resistance and glycaemic control over 24 weeks. The therapy also decreased serum triglycerides and uric acid, mitigating liver toxicity and metabolic complications.
In addition to pharmacological interventions, lifestyle modifications, such as adherence to the Mediterranean diet and regular exercise, play a vital role in managing NAFLD. These non-pharmacological strategies improve metabolic markers and hepatic fat content, reinforcing the importance of a holistic care model.
While ertugliflozin offers significant therapeutic benefits, current studies have limitations, such as small sample sizes and insufficient data on dietary interventions. Future large-scale, multicentre trials integrating pharmacological and lifestyle strategies will be crucial in optimising outcomes for patients with NAFLD and T2DM.
Ertugliflozin’s multifaceted benefits position it as a valuable therapeutic option, not only for glycaemic control but also for addressing the interconnected complications of NAFLD and T2DM. Its use underscores the need for an integrated, multidisciplinary approach to managing these complex metabolic conditions.
Katie Wright, EMJ
Reference
Khaliq A et al. The effect of ertugliflozin in patients with nonalcoholic fatty liver disease associated with type 2 diabetes mellitus: A randomized controlled trial. Medicine (Baltimore). 2024;103(45):e40356.
