New Treatments for Diabetes-Related Fatty Liver Disease Show Promising Results
Fatty liver disease associated with metabolic disorders, also known as hepatic steatosis, affects nearly 40% of the global population. It is characterized by an excessive accumulation of fat in the liver and can progress to inflammation, fibrosis, or even cirrhosis. By 2040, its prevalence could reach 55%, in parallel with the increase in type 2 diabetes and obesity. About two-thirds of people with type 2 diabetes develop this liver disease, and one-third of them see their condition worsen into metabolic steatohepatitis, a more severe form.
This condition is not limited to the liver. It also increases the risk of cardiovascular events, the leading cause of mortality in these patients. The severity of the disease depends mainly on the degree of fibrosis, i.e., the scarring of the liver. The more advanced the fibrosis, the higher the risk of complications and death. Diabetic individuals with confirmed fibrosis have a fourfold higher risk of mortality over five years compared to others.
Among the treatments available for type 2 diabetes, some have proven effective against hepatic steatosis. Semaglutide, an injectable medication, is the most studied. It not only reduces blood sugar and weight but also improves liver inflammation and even slows the progression of fibrosis. Clinical trials have shown that nearly 60% of treated patients see their steatohepatitis disappear without worsening fibrosis. This drug is now specifically approved for this indication.
Other treatments such as tirzepatide and dapagliflozin also show beneficial effects. Tirzepatide, which acts on two hormones regulating blood sugar, significantly reduces liver fat and improves liver condition in more than half of patients. Dapagliflozin, on the other hand, reduces steatosis and may also alleviate fibrosis, although further evidence is needed.
Pioglitazone, a drug that improves insulin sensitivity, reduces liver inflammation and promotes the disappearance of steatohepatitis in a large proportion of patients. However, its impact on fibrosis is more modest, and its use must be cautious due to risks of side effects such as water retention.
Emerging therapies directly target the liver. Resmetirom, recently approved, works by activating a liver receptor that regulates fat metabolism. It reduces inflammation and fibrosis without causing weight loss. Other molecules in development, such as combined glucagon and GLP-1 agonists, could offer even more effective solutions. These treatments combine multiple mechanisms of action to reduce liver fat, improve inflammation, and slow fibrosis.
The rapid evolution of therapeutic options paves the way for comprehensive patient management, integrating metabolic, hepatic, and cardiovascular risks. Physicians now have tools to better tailor treatments to individual needs. Combining lifestyle changes, such as a balanced diet and regular physical activity, remains essential to maximize benefits. Even moderate weight loss already improves liver condition and reduces complications.
These advances offer concrete hope for the millions of people affected by this silent but serious disease. Ongoing research should further expand treatment possibilities in the coming years.
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Original Publication
DOI: https://doi.org/10.1007/s11892-026-01621-w
Title: Pharmacologic Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease in the Context of Type 2 Diabetes
Journal: Current Diabetes Reports
Publisher: Springer Science and Business Media LLC
Authors: Konstantinos Malandris; Konstantinos Charalampidis; Rohit Loomba; Emmanouil Sinakos