Dipeptidyl Peptidase IV Inhibitor Improves Insulin Resistance and Steatosis in a Refractory Nonalcoholic Fatty Liver Disease Patient: A Case Report

Abstract

A 67-year-old Asian woman was referred to Kurume University Hospital due to abnormal liver function tests. She was diagnosed with nonalcoholic fatty liver disease (NAFLD). NAFLD was treated by diet therapy with medication of metformin and pioglitazone; however, NAFLD did not improve. Subsequently, the patient was administered sitagliptin. Although her energy intake and physical activity did not change, her hemoglobin A1c level was decreased from 7.8 to 6.4% 3 months after treatment. Moreover, her serum insulin level and homeostasis model assessment-insulin resistance value were also improved, as was the severity of hepatic steatosis. These findings indicate that sitagliptin may improve insulin resistance and steatosis in patients with refractory NAFLD.

Pharmacokinetics in Patients with Chronic Liver Disease and Hepatic Safety of Incretin-Based Therapies for the Management of Type 2 Diabetes Mellitus

“…The efficacy of sitagliptin therapy has been shown in patients with T2DM complicated by NAFLD [27][28][29][30] , NASH [31] or CLD caused by hepatitis C virus [32] . However, one report suggested that NAFLD may adversely affect the glycaemic control obtained with sitagliptin [33] .…”

Effect of sitagliptin on epicardial fat thickness in subjects with type 2 diabetes and obesity: a pilot study

“…This hypothesis may be supported by some previous observations. Sitagliptin reduced hepatic steatosis [32,33], which is closely linked to epicardial fat, as recently reported [34]. Furthermore, GLP-1 receptor expression in adipose tissue has been established [35] and agonists of this receptor have recently been shown to induce short term, noticeable, and significant EAT thickness reduction in type 2 diabetes patients [36], suggesting that a prolonged halflife of GLP-1 mediated by the inhibition of DPP-4 bears an important influence on the adipose reduction of this tissue.…”

Pharmacokinetic and toxicological considerations for the treatment of diabetes in patients with liver disease

“…The efficacy and safety of sitagliptin therapy has been shown in patients with diabetes complicated by NAFLD [76][77][78], NASH [79] or CLD caused by hepatitis C virus [80].…”