Potential Effects of Dapagliflozin in the Management of Diabetic Patients with NAFLD:

Systematic Review and Meta-Analysis

Heriansyah MD,

Abstract

BACKGROUND:

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. Diabetes
and metabolic syndrome is one of the prominent cause of NAFLD. Current treatment aims for
lifestyle medification and intervention for the underlying disorders such as insulin resistance,
hyperglycemia, and dyslipidemia. Dapagliflozin is a potent and selective SGLT2 inhibitor. Many
studies have shown that dapagliflozin can decreased liver enzyme, blood lipid, and hepatic fibrosis
in mice model. This study conducted to find a beneficial effect of dapaglifozin in diabetic patients
with/at risk of NAFLD.

METHODS:

Literature search was conducted using Pubmed database until August 2019 to find randomized
controlled trial (RCTs), which assessed Dapagliflozin administration on blood lipid, insulin
resistance, liver enzyme and body weight in diabetic patients with/at risk of NAFLD.. Treatment
effects were considered as mean and standard deviation (SD) difference from the baseline. We
performed data analysis using RevMan 6.3. We used random-effects model to estimate the overall
summary effect of this study.

RESULTS:

A total of 3 trials (154 participants) were included in the meta-analysis. The results suggested that
dapagliflozin has significant effect improving AST (-4.47 U/L, 95%CI:-7.06 to -1.88; p=0.0007),
ALT (-8.55 U/L, 95%CI:-12.22 to -4.87; p<0.00001), GGT (-7.66 U/L, 95%CI:-14.72 to -0.59;
p=0.03), HOMA-IR (-0.92, 95%CI:-1.72 to -0.11; p=0.03), body weight (-2.24 Kg, 95%CI:-3.18
to -1.29; p<0.00001) and BMI (-0.79 Kg/m2, 95%CI:-1.32 to -0.27; p=0.003). Dapaglifozin has no
significant effect on total cholesterol (2.98 mg/dL, 95%CI:-6.14 to 12.10; p=0.52), LDL (3.18
mg/dL, 95%CI:-3.50 to 9.85; p=0.60), HDL (1.74 mg/dL, 95%CI:-0.12 to 3.6; p=0.07), and
triglycerides (1.44 mg/dL, 95%CI:-12.41 to 15.30; p=0.84).

CONCLUSIONS:

Dapaglifozin is beneficial for diabetic patient with/at risk of NAFLD by improving metabolic
parameter and liver enzyme. However, further studies with larger scale and better designs are
needed to confirm the results and eliminate the bias.