Summary:
Objectives:To evaluate and compare the effectiveness of
metformin plus pioglitazone versus metformin alone in
treatment of raised alanine aminotransferase (ALT) in nonalcoholic
fatty liver disease (NAFLD) in patients with newly
detected diabetes mellitus (DM) and impaired glucose
tolerance (IGT).
Materials and methods: In this open label clinical trial,
newly detected DM and IGT patients with raised ALT and
ultrasound proven NAFLD were treated with either
metformin and pioglitazone combination (group 1) or
metformin alone (group 2). They were followed up upto 6
months.
Results:Total number of patients was 49 (27 in group 1 and
22 in group 2) and there was male predominance in either
group. Age was almost identical between two groups (46±9.3
and 45.4±5.7 years in group 1 and group 2 respectively).
Significant reduction in values of fasting blood glucose
(FBG), 2 hours post breakfast values (ABF), HbA1c,
cholesterol (CHOL), triglycerides (TG) and ALT of the study
subjects were achieved in either group after six months
(Group 1: FBG 8.89±1.4 vs 6.37±0.5 mmol/l, ABF 13.2±2.07
vs 8.34±0.84 mmol/l, HbA1c 8.15±0.87 % vs6.7±0.40%,
CHOL 205.26±30.74 vs 178.89±18.59 mg/dl, TG
226.15±50.06 vs 155.85±20.99 mg/dl, ALT 91.52±23.14 vs
45.74±12.63 mg/dl and in Group 2 : FBG 9.39±2.26 vs
6.98±1.20 mmol/l, ABF 13.38±2.93 vs 9.13±1.46 mmol/l,
HbA1c 8.10±0.92 % vs7.03±0.71%, CHOL 206.55±29.9 vs
195±23.55 mg/dl, TG 235.59±46.22 vs 178.91±38.24 mg/
dl, ALT 105.59±18.63 vs 66.36±16.02 mg/dl).In comparison
between two groups, Group 1 had better metabolic control
compared to their counterpart of Group 2 at the end of 6
months [Group 1 vs Group 2: FBG (p=0.024), ABF
(p=0.022), CHOL (p = 0.010), TG (p =0.010)]. There was
significant reduction in ALT as well (p = 0.000).
Conclusion:Combination of metformin and pioglitazone is
more effective than metformin alone in reducing ALT in
NAFLD in newly detected DM and IGT patients.