Effects of sodium–glucose cotransporter 2 inhibitors on non‐alcoholic fatty liver disease in patients with type 2 diabetes: A meta‐analysis of randomized controlled trials

AIMS/INTRODUCTION: Non‐alcoholic fatty liver disease (NAFLD) is increasingly common in patients with type 2 diabetes mellitus. Currently, some studies have found that sodium–glucose cotransporter 2 (SGLT2) inhibitors, a new hypoglycemic drug, can improve non‐alcoholic fatty liver in addition to its hypoglycemic effect. Thus, we undertook a meta‐analysis of randomized controlled trials to evaluate the efficacy of SGLT2 inhibitors on the treatment of NAFLD. MATERIALS AND METHODS: PubMed, Embase and the Cochrane Library were searched for randomized controlled trials of SGLT2 inhibitors in patients with NAFLD and type 2 diabetes mellitus up to 1 October 2019. Differences were expressed as weight mean difference (WMD) with 95% confidence interval (CI) for continuous outcomes. The I (2) statistic was applied to evaluate the heterogeneity of studies. RESULTS: A total of six trials including 309 patients were selected into our meta‐analysis. SGLT2 inhibitors could reduce alanine aminotransferase (WMD −11.05 IU/L, 95% CI −19.85, −2.25, P = 0.01) and magnetic resonance imaging proton density fat fraction (WMD −2.07%, 95% CI −3.86, −0.28, P = 0.02). However, SGLT2 inhibitors did not reduce aspartate aminotransferase (WMD −1.11 IU/L, 95% CI −2.39, 0.17, P = 0.09). In addition, secondary outcomes, such as bodyweight and visceral fat area, were also reduced (WMD −1.62 kg, 95% CI −2.02, −1.23, P < 0.00001; WMD −19.98 cm(2), 95% CI −27.18, −12.79, P < 0.00001, respectively). CONCLUSIONS: SGLT2 inhibitors can significantly decrease alanine aminotransferase and liver fat, accompanied with weight loss, which might have a positive effect on fatty liver in patients with type 2 diabetes mellitus. The limitation is that the sample size of the studies was small. Therefore, more large randomized controlled trials specified on NAFLD are required to evaluate these results.