2019 年 3 巻 p. 11-19
Aim: Sodium-glucose cotransporter 2 inhibitors are novel antidiabetic agents that inhibit glucose reabsorption in the renal proximal tubules. We assessed the potential effects of sodium-glucose cotransporter 2 inhibitors on body weight, hepatic fat accumulation, and liver stiffness by using transient elastography (TE) and measuring biochemical markers associated with nonalcoholic fatty liver disease (NAFLD) with type 2 diabetes mellitus (T2DM).
Methods: For 12 weeks, patients with T2DM and NAFLD were treated by ipragliflozin as an add-on medication. Physical findings, biochemical blood and urinary analyses, meal tolerance test, and TE were assessed before and 12 weeks after the administration of ipragliflozin.
Results: Fifteen patients were enrolled in this study. From baseline to 12 weeks, body mass index (BMI; p < 0.0001), hemoglobin A1c (p < 0.01), and fasting and postprandial plasma glucose (p < 0.05 and p < 0.01, respectively) were significantly reduced. Fasting C-peptide immunoreactivity index (p < 0.05), urinary glucose (p < 0.001), and hematocrit (p < 0.01) were significantly increased. Uric acid (p < 0.01), γ-glutamyl transpeptidase (p < 0.05), ferritin (p < 0.001), hepatic fat accumulation (i.e., the controlled attenuation parameter [CAP]; p < 0.05), and liver stiffness (E; p < 0.05) were significantly decreased, as measured by TE. The percent change in BMI and the change in the aspartate aminotransferase, alanine aminotransferase (ΔALT), and type IV collagen 7s levels, and in the aspartate aminotransferase-to-platelet ratio index and fibrosis-4 index values were correlated with the change in the CAP (ΔCAP). The ΔALT was the only independent predictor of ΔCAP, based on multivariate analysis (p < 0.01).
Conclusions: The administration of the sodium-glucose cotransporter 2 inhibitor ipragliflozin may be associated with the amelioration of hepatic steatosis and elasticity in patients with T2DM and NAFLD.
