Impact of empagliflozin on liver fat reduction in type 2 diabetes and NAFLD: A systematic review and meta-analysis.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) and type 2 Diabetes Mellitus are the major causes of significant mortality and morbidity. NAFLD and type 2 diabetes have common risk factors. SGLT-2 inhibitors are believed to have a beneficial effect on liver fat in patients with NAFLD and type 2 diabetes. However, there are limited data available on this aspect of empagliflozin use. Thus, we aimed to compare the impact of empagliflozin on liver fat reduction in type 2 diabetes and NAFLD. METHODS: A comprehensive search of databases like PubMed, Google Scholar, and Cochrane Library was done. In the end, a detailed analysis was performed on a total of 6 finalized studies, all of which were randomized controlled trials. This comprehensive analysis consisted of a cohort of 589 Individuals. RESULTS: A total of six studies were included. Primary outcomes assessed were MRI-PDFF, AST, ALT, HOMA-IR and total bilirubin. Empagliflozin significantly reduced liver fat compared to placebo, with a pooled standardized mean difference (SMD) of −0.43 (95% CI: −0.82 to −0.04; p = 0.03; I² = 0%). AST also showed a significant reduction (SMD = −0.41; 95% CI: −0.66 to −0.16; p = 0.001; I² = 34%), while ALT showed a non-significant trend favoring empagliflozin (SMD = −0.60; 95% CI: −1.25 to 0.04; p = 0.07) with high heterogeneity (I² = 91%). No significant effects were observed for HOMA-IR (SMD = −0.10; 95% CI: −0.43 to 0.24; p = 0.57) or total bilirubin (SMD = −0.04; 95% CI: −1.16 to 1.08; p = 0.94). Among secondary outcomes, only liver segment VIII showed a significant benefit (SMD = −0.97; 95% CI: −1.68 to −0.25; p = 0.008), though heterogeneity remained substantial (I² = 79%). No significant changes were found in total cholesterol. CONCLUSION: MRI-PDFF showed that empagliflozin significantly reduced liver fat and AST levels, indicating a beneficial effect on liver health in patients with type 2 diabetes and NAFLD.