Impact of Sodium-Glucose Co-Transporter Type-2 Inhibitors on Alanine Aminotransferase Levels in Type-2 Diabetes Patients Having Features of Nonalcoholic Fatty Liver Disease: A Retrospective Cohort Study in Pakistan

Objective: We aimed to elucidate the effectiveness of Sodium-glucose co-transporter-2 inhibitors (SGLT2-I) in the reduction of ALT among Type-2 diabetes patients (T2DM) with Non-alcoholic fatty liver disease (NAFLD). Methods: We retrospectively collected data from 120 files of T2DM, aged 30-60 years, with elevated ALT, and documented follow-up for one year from August 2018-July 2019. The effects of SGLT2Is (Dapagliflozin and Empagliflozin) were evaluated using Generalized Estimating Equation (GEE) for analysis. Results: The overall mean age was 48.9 ± 7.3 years, 57.5% were females, and the mean duration of diabetes was 8.5 ± 5.6 years. At baseline, the mean BMI was 32.5 ± 5.7 kg/m², mean ALT was 51.6 IU/L ± 17.8 IU/L, and mean HbA1c was 8.5% ± 1.5%. There was a statistically significant reduction in mean ALT of 2.2 IU/L (p-value 0.02) with every 10 mg/dl increase in LDL among females using 10 mg Empagliflozin as compared to males not on SGLT2i. Conclusions: We observed an average reduction in mean ALT levels when SGLT2Is was initiated in T2DM patients having NAFLD. Apart from encouraging diet and lifestyle modification, early intervention with SGLT2Is may decrease liver-related morbidity and mortality resulting from NAFLD.