Metformin and Diammonium Glycyrrhizinate Enteric-Coated Capsule versus Metformin Alone versus Diammonium Glycyrrhizinate Enteric-Coated Capsule Alone in Patients with Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus

Abstract

Objective. The present study was conducted to compare the efficacy of metformin combined with diammonium glycyrrhizinate enteric-coated capsule (DGEC) versus metformin alone versus DGEC alone for the treatment of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). Subjects and Methods. 163 patients with NAFLD and T2DM were enrolled in this 24-week study and were randomized to one of three groups: group 1 was treated with metformin alone; group 2 was treated with DGEC alone; group 3 received metformin plus DGEC combination therapy. Anthropometric parameters, liver function, lipid profile, serum ferritin (SF), metabolic parameters, liver/spleen computed tomography (CT) ratio, and fibroscan value were evaluated at baseline and after 8, 16, and 24 weeks of treatment. Results. After 24 weeks, significant improvements in all measured parameters were observed in three groups (P < 0.05) except for the improvements in low density lipoprotein cholesterol (LDL-C) and metabolic parameters in group 2 which did not reach statistical significance (P > 0.05). Compared with group 1 and group 2, the patients in group 3 had greater reductions in observed parameters apart from CB and TB (P < 0.05). Conclusions. This study showed that metformin plus DGEC was more effective than metformin alone or DGEC alone in reducing liver enzymes, lipid levels, and metabolic parameters and ameliorating the degree of hepatic fibrosis in patients with NAFLD and T2DM.

The Relationship Between Liver Enzymes and Insulin Resistance in Type 2 Diabetes Patients with Nonalcoholic Fatty Liver Disease

“…Epidemiological studies have shown that the prevalence of NAFLD ranges from 20-40 % in western countries, 12-30 % in Asian countries, and 20.9 % in the Chinese mainland [18]. Approximately 75 % of type 2 diabetes patients have fatty liver disease [2], and NAFLD is highly prevalent with type 2 diabetes, as they have common pathogenic mechanisms.…”

Diammonium Glycyrrhizinate Protects against Nonalcoholic Fatty Liver Disease in Mice through Modulation of Gut Microbiota and Restoration of Intestinal Barrier

“…Diammonium glycyrrhizinate (DG), a medicinal form of glycyrrhizic acid as well as a natural and major bioactive pentacyclic triterpenoid glycoside extracted from licorice roots, possesses comprehensive pharmacological properties such as antiviral, anti-inflammatory, antiallergic, antioxidant, and antitumor characteristics, among others. − DG is commonly used as one of therapeutic agents for the treatment and control of chronic hepatopathy including NAFLD. − It also has been proven to alleviate serum liver enzymes and ameliorate pathological damage of the liver because of its anti-inflammatory mechanisms of action in the liver. ,− Previous studies have shown that DG was mainly distributed in the liver and intestines after being absorbed into the blood . In addition, it can significantly alleviate the intestinal mucosa inflammation in mice .…”

Effects of Metformin on Hepatic Steatosis in Adults with Nonalcoholic Fatty Liver Disease and Diabetes: Insights from the Cellular to Patient Levels

“…In eight studies that reported the effects of metformin in diabetic NAFLD patients compared to the pretreatment baseline condition, the patients were treated with metformin at dosages ranging from 1,000 to 2,000 mg/day for 12 to 48 weeks. [46][47][48][49][50][51][52][53] These studies had various methods of NAFLD diagnosis, including ultrasonographic assessment of hepatic steatosis, a quantitative ultrasonographic method, or a liver/spleen computed tomography ratio (L/S CT ratio) of less than 1. One study included the patients who underwent liver biopsy and were diagnosed as NASH.…”

“…Five studies showed that metformin treatment for 12 to 24 weeks reduced the body mass index (BMI), liver fat content, liver enzymes, and hemoglobin A1c (HbA1c) and improved insulin resistance in NAFLD patients with type 2 diabetes mellitus (T2DM). [46][47][48][49][50] A prospective study in 11 patients with new-onset T2DM showed lower amounts of fat in the liver after 16 weeks of metformin treatment. 53 However, one study reported inconsistent findings.…”

“…Metformin treatment significantly decreased liver fibrosis evaluated by noninvasive measurement in NAFLD patients. 46 However, inconsistent report exists. No significant improvement of fibrosis was demonstrated in histologic NASH patients (n=10) evaluated by liver biopsy.…”