Effects Of Dapagliflozin On Non-alcoholic Fatty Liver Disease In Patients With Type 2 Diabetes

Objective:To observe the effects of dapagliflozin on hepatic fat content,glucose and lipid metabolism in type 2 diabetes(T2DM)patients with non-alcoholic fatty liver disease(NAFLD).Methods:1 We selected outpatient and inpatient patients with T2 DM and NAFLD of the endocrine metabolism department of cangzhou people’s hospital as the study subjects.2 We used the liver-to-spleen ratio(L/S)by computed tomography to quantitatively analyze the changes in hepatic fat content.We collected the patients’ general information,body weight,body mass index(BMI),visceral fat area(VFA),total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C),fasting plasma glucose(FPG),glycosylated hemoglobin(Hb A1c),aspartate aminotransferase(AST),alanine aminotransferase(ALT),uric acid(UA),fasting insulin(FINS)and fasting C-peptide.The steady-state model were used to calculate indexes of insulin resistance(HOMA IR)= FPG(mmol/L)× FINS(m U/L)/ 22.5.3 We collected the above indexes of each patient again after 12 weeks of dapagliflozin(10mg)and regularly followed up of adverse reactions.4 We analyzed the differences of above indexes between before and after treatment by the paired t-test.We calculated the correlation coefficients between the change of liver-to-spleen attenuation ratio(ΔL/S)and the change of other indexes by Pearson’s methods,and we analyzed the affecting factors of ΔL/S.Results:1 General dataA total of 32 subjects completed the 12-week trial,including 17 males and 15 females,with an average age of 48.69±7.61 years and a diabetes duration of 1.88±0.80 years.During this study,all participants were not have severe hypoglycemia,genitourinary infection,diabetic ketoacidosis or other adverse reactions.2 Effects of dapagliflozin on hepatic fat content,glucose and lipid metabolism indexesAfter treatment for 12 weeks of dapagliflozin,L/S was significantly higher than before treatment,the difference was statistically significant(P<0.001);body weight,BMI and VFA decreased,FPG,Hb A1 c,TG,ALT,UA,FINS,fasting C-peptide and HOMA-IR were significantly lower than those before treatment,and the difference was statistically significant(P<0.05);while there was no statistically significant differences of the levels of AST,TC,HDL-C and LDL-C(P>0.05).3 The results of Pearson’ correlationsWe used Pearson’ correlations to analysis the difference between ΔL/S and other indexes before and after treatment(Δ: difference before and after treatment).It was found that there was a negative correlation between ΔL/S and Δbody weight,ΔBMI,ΔVFA,ΔFPG,ΔHb A1 c,ΔTG,ΔALT,ΔFINS andΔHOMA-IR(r=-0.557,-0.574,-0.542,-0.485,-0.482,-0.364,-0.456,-0.406,-0.365,P<0.05).4 Multiple linear regression analysis of factors affecting ΔL/SMultiple linear regression analysis was conducted with ΔL/S as the dependent variable and Δbody weight,ΔBMI,ΔVFA,ΔFPG,ΔHb A1 c,ΔTG,ΔALT,ΔFINS and ΔHOMA-IR as the independent variables.The results showed that ΔVFA(β=-0.287,P < 0.05),ΔFPG(β=-0.403,P < 0.05),ΔHb A1c(β=-0.390,P < 0.05)and ΔALT(β=-0.469,P < 0.05)were independently correlated with ΔL/S.Conclusion:1 L/S significantly increased in patients with T2 DM and NAFLD after treatment with dapagliflozin for 12 weeks.2 The increase of L/S in patients with T2 DM and NAFLD is independently related to the improvement of ALT,VFA,FPG,and Hb A1 c.