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By Alex Morrisson

BERLIN -- October 5, 2012 -- Patients with non-alcoholic fatty liver disease who are newly diagnosed with glucose intolerance appear to more effectively reduce elevated liver enzymes if they are treated with a combination of metformin plus pioglitazone instead of metformin monotherapy, researchers said here at the 48th Annual Meeting of the European Association for the Study of Diabetes (EASD).

“After 6 months of therapy we observed significant reductions in alanine aminotransferase, glycated haemoglobin A1C, cholesterol, triglycerides, and other factors with both metformin alone and with the combination, but there was a greater reduction with the combination treatment,” said Rezina Sultana, MD, Bangladesh Institute of Research, and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh.

She said that of the 27 patients who were treated with pioglitazone 30 mg plus metformin 1700 mg, 77.7% showed significant reversal of fatty changes in the liver compared with 18.8% of the 22 patients who were assigned to metformin 1700 mg alone (P =.000).

At her poser discussion session October 4, 2012, Dr. Sultana also found that treatment with combination reduced total cholesterol. The mean cholesterol among the patients on the combination was 178.89 mg/dl compared to 195 mg/dl for those on metformin monotherapy.

Fasting blood glucose after 6 months was 6.37 with the combination, compared with 6.98 with metformin alone (P =.024).

For the study, Dr. Sultana and colleagues recruited patients with newly detected abnormal glucose tolerance who were also naïve to treatment with any anti-diabetic drug. They were randomly selected from the gastroenterology out-patient department at BIRDEM. If an ultrasound examination found evidence of fatty liver changes and ALT elevations, the patients were assigned to either the combination therapy or metformin monotherapy.

The mean age of the participants was 45.8 years. About 65% of the group was men.

[Presentation title: A Comparative Study With Metformin and Pioglitazone versus Metformin Alone in Nonalcoholic Fatty Liver Disease in Newly Detected Glucose Intolerant Patients. Abstract 1232]
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