Hormonal
Adding a GLP-1 agonist (oral semaglutide) to SGLT2 inhibitor therapy in patients with T2DM and NAFLD who have experienced SGLT2I rebound or failure significantly improves visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and glycemic control (HbA1c).
If you have Type 2 Diabetes and fatty liver, and your current SGLT2 inhibitor medication (like luseogliflozin) stops working or your liver enzymes/blood sugar start to worsen, adding a GLP-1 agonist (like oral semaglutide) can significantly help reduce visceral and subcutaneous fat and improve blood sugar control. This strategy is specifically for those who do not respond well to SGLT2 inhibitors alone.
GLP-1A addition improved the BMI (25.2 to 23.5 kg/m2) and hemoglobin A1c (6.5% to 6.2%, p=0.001). A further analysis revealed additional improvement in SATI (66.1 to 56.6, p=0.007) and a significant decrease in VATI (51.5 to 48.3, p=0.001).
Why this rating
Small sample size (n=15), retrospective design, single-center, no control group for the add-on phase.
Source
Clinical Efficacy and Body Composition Changes with Sodium Glucose Cotransporter 2 Inhibitor/Glucagon-like Peptide-1 Antagonist Combination Therapy in Patients with Type 2 Diabetes Mellitus-associated Nonalcoholic Fatty Liver Disease
Toru Ishikawa et al. · Internal Medicine · 2024
DOI 10.2169/internalmedicine.3259-23
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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