Amelioration of liver function and glucose control with pioglitazone in a patient with diabetes mellitus type 2 and nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of hepatic steatosis and elevated aminotransferases in the general population. It is a benign disease; however, in a portion of patients it progresses to nonalcoholic steatohepatitis (NASH) and cirrhosis. The most effective but the most difficult treatment for it is body mass reduction by behavior interventions. Different drugs have been tested in the treatment of NAFLD but their effect was not satisfactory; therefore, there is no regular, causal and pharmacological treatment for NAFLD at the moment. The etiology of NAFLD is unclear but insulin resistance is believed to play a significant pathogenic role. Data concerning the possibilities of using oral antidiabetic drugs in the treatment of NAFLD are limited. Among insulin sensitizers, metformin is a first-line drug in the treatment of diabetes type 2; however, due to its gastro-intestinal adverse reactions, some patients cannot use it or cannot achieve an optimal treatment dose. On the other hand, the drug is contraindicated for some patients. In this case study, we present a patient with diabetes mellitus type 2 with elevated aminotransferases levels related to NAFLD and inadequate glucose control, who has been treated with a sulphonylurea derivative and dipeptydylo peptidase IV inhibitor. Replacement of previously used drugs by basal insulin and pioglitazone resulted in both the reduction of the activity of liver enzymes and the improvement in glucose control.