비알콜성 지방간을 가진 제2형 당뇨병 환자에서 지방간 개선에 대한 Dapagliflozin의 효과
Effect of Dapagliflozin on Fatty Liver Improvement in Type 2 Diabetes Patients with Nonalcoholic Fatty Liver Disease
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Background : The global prevalence of type 2 diabetes mellitus (T2DM) is rapidly growing worldwide, and accordingly, the number of patients with concomitant diseases is increasing. Type 2 diabetes mellitus is closely related to nonalcoholic fatty liver disease (NAFLD), and in this study, a meta-analysis was conducted to investigate the effect of dapagliflozin on improving liver enzyme levels in NAFLD patients taking. Methods : This study identified eligible trials based on MeSH terms in the PubMed, EMBASE, and CENTRAL database published from 2012 to March 2020 that reported effects on liver outcomes in patients with type 2 diabetes. The primary outcomes were alanine aminotransferase (ALT), aspartate aminotransferase (AST), and fibrosis-4 (FIB-4) index scores and the second outcomes were body mass index (BMI), and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels. For the statistical analysis, standardized mean difference (SMD) was calculated at 95% confidence intervals (CIs), and fixed or random-effects models were used to assess the outcomes. Results : From the 423 records identified, seven articles with a total of 795 patients met the inclusion criteria and were analyzed. Compared to the placebo or other diabetes medication groups, patients treated with dapagliflozin showed significantly decreased adjusted mean change in ALT levels (p=0.0002, SMD=-0.39), but no major difference was found in AST levels (p=0.10, SMD=-0.24) or FIB-4 index scores (p=0.19, SMD=-0.11). BMI (p=0.008, SMD=-1.20) was significantly decreased, but the HDL and LDL cholesterol levels showed no major differences. Conclusion : Reductions in the ALT levels and BMI by dapagliflozin suggest that it may help prevent liver damage in type 2 diabetes patients with NAFLD. Although more research is needed, dapagliflozin may be a suitable treatment strategy for T2DM patients with non-alcoholic fatty liver, which will provide a clinical reference for the treatment of T2DM.
Abstract
Background : The global prevalence of type 2 diabetes mellitus (T2DM) is rapidly growing worldwide, and accordingly, the number of patients with concomitant diseases is increasing. Type 2 diabetes mellitus is closely related to nonalcoholic fatty liver disease (NAFLD), and in this study, a meta-analysis was conducted to investigate the effect of dapagliflozin on improving liver enzyme levels in NAFLD patients taking. Methods : This study identified eligible trials based on MeSH terms in the PubMed, EMBASE, and CENTRAL database published from 2012 to March 2020 that reported effects on liver outcomes in patients with type 2 diabetes. The primary outcomes were alanine aminotransferase (ALT), aspartate aminotransferase (AST), and fibrosis-4 (FIB-4) index scores and the second outcomes were body mass index (BMI), and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels. For the statistical analysis, standardized mean difference (SMD) was calculated at 95% confidence intervals (CIs), and fixed or random-effects models were used to assess the outcomes. Results : From the 423 records identified, seven articles with a total of 795 patients met the inclusion criteria and were analyzed. Compared to the placebo or other diabetes medication groups, patients treated with dapagliflozin showed significantly decreased adjusted mean change in ALT levels (p=0.0002, SMD=-0.39), but no major difference was found in AST levels (p=0.10, SMD=-0.24) or FIB-4 index scores (p=0.19, SMD=-0.11). BMI (p=0.008, SMD=-1.20) was significantly decreased, but the HDL and LDL cholesterol levels showed no major differences. Conclusion : Reductions in the ALT levels and BMI by dapagliflozin suggest that it may help prevent liver damage in type 2 diabetes patients with NAFLD. Although more research is needed, dapagliflozin may be a suitable treatment strategy for T2DM patients with non-alcoholic fatty liver, which will provide a clinical reference for the treatment of T2DM.
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