A chronic metabolic disorder described by continuous hyperglycemia we call Diabetes mellitus
or DM. this metabolic disorder could be for various reasons like resisting to marginal action
of insulin, also could be due to diminished secretion of insulin, or maybe both. This Chronic
hyperglycemia could be responsible for other kinds of abnormalities and therefore damage
various organs in the patient, sometimes this also could even be life threatening
complications.
NAFLD (Nonalcoholic fatty liver disease) has the highest incidence rate among obese and
diabetic patients. In various studies, it has been found that Type 2 diabetes mellitus (T2DM)
and nonalcoholic fatty liver disease (NAFLD) exist together which is a metabolic disorder. It
has been found that the occurrence of NAFLD is 59.67% among T2DM patients with nonalcoholic
steatohepatitis (NASH), simple steatosis (NAFL), and cirrhosis.
The studies reveal that NAFLD of 70% is usually found among T2DM patients. It is also
observed that obesity and insulin resistance is correlated with NAFLD.
Noninvasive assessment and staging of disease are based on clinical parameters such as age,
sex, liver function test, platelet count, lipid profile, BMI, and imaging modalities such as
USG, Fibro-scan (FS), and magnetic resonance imaging mass spectroscopy. Such clinical scoring
systems and TE are useful in the early detection of NAFLD and predicting fibrosis. The
principle behind the management of NAFLD with T2DM involves an indirect effect through
improvement in IR and glycemia and thus is used for the treatment of T2DM as well.
In addition to this, fatty pancreas is gaining importance from the research point of view.
Study done by our group also showed that subcutaneous and intra-abdominal obesity, including
fatty liver and pancreatic volume, were larger in non-obese Asian Indians with type 2
diabetes than in BMI-matched non-diabetic participants, whereas peripheral subcutaneous
adiposity was lower. A study done in animal model shows that metformin exerted a beneficial
effect in limiting beta-proliferation caused by high fat diet (HFD) fed to mice and also
improved insulin resistance. Another study also showed similar effects of Metformin therapy,
as it decreased the amount of fat in the liver in parallel with an improvement in the
metabolic parameters and may, thus, be beneficial for preventing the late consequences of
NAFLD in newly diagnosed diabetic patients.
The study mentioned below predicted that Metformin would considerably reduce pancreatic and
liver fat in T2DM patients. Metformin does not appear to cause or exacerbate liver injury
and, indeed, is often beneficial in patients with nonalcoholic fatty liver disease.
Nonalcoholic fatty liver frequently presents with transaminase elevations but should not be
considered a contraindication to metformin use. Literature evidence of liver disease being
associated with metformin-associated metabolic acidosis is largely represented by case
reports.
A recent study from Korea shows that in patients with type-2 diabetes mellitus, the mean
FIB-4 score increased from 1.38 to 1.51 (p=0.001) after 2 years of metformin therapy, whereas
the mean HSI score fell from 27.3 to 26.5 (p=0.001).
While these studies established that hepatic fat and pancreatic volume are high even in
non-obese patients with T2DM, we were unable to estimate of hepatic and pancreatic fat
precisely due to non-availability of advanced fat-imaging MRI software.
Review of Literature: Effects of SGLT2 Inhibitors and Abdominal Adipose Tissue Depots
Metformin is an effective agent which helps to achieve better blood glucose control. This
drug also benefits in the reduction of weight and blood pressure. Metformin results in weight
loss.
Effect on Fat Mass:
Apart from weight loss, Metformin has been shown to reduce fat. It was reported that the use
of Metformin significantly reduces body weight in T2DM patients on metformin therapy and
inadequate glycemic control.
