Comparative Effects of Sodium-Glucose Cotransporter 2 Inhibitors and Thiazolidinediones on the Fatty Liver Index in Adults with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Nonalcoholic fatty liver disease (NAFLD) commonly coexists with type 2 diabetes mellitus (T2DM) and contributes substantially to the global burden of chronic liver disease.Among pharmacological options, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and thiazolidinediones (TZD) show mechanistic potential for hepatic benefit; however their comparative effects remain uncertain.This systematic review and meta-analysis evaluated the impact of SGLT2i and TZD on hepatic steatosis, measured by the Fatty Liver Index (FLI), in adults with NAFLD and T2DM.Comprehensive searches of five databases through April 2025 identified nine eligible studies (n = 1,348; mean age 53 years; 53% women) with intervention durations of 12-52 weeks.Random-effects models were used to pool mean differences (MD) in FLI, and risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale.Compared with baseline or standard care, SGLT2i significantly reduced FLI (MD -8.2; 95% CI -11.4 to -5.0; I² = 42%), whereas TZD showed a non-significant change (+1.9; -0.7 to +4.6; I² = 37%).In two head-to-head trials, SGLT2i demonstrated superior efficacy over pioglitazone (MD -10.6; -13.3 to -7.9; I² = 0%).Funnel plot symmetry suggested minimal bias, although Egger's test indicated possible small-study effects.Certainty of evidence was graded as moderate for SGLT2i and low for TZD due to study size, heterogeneity, and reliance on surrogate markers.Overall, SGLT2i produced clinically meaningful reductions in FLI and consistently outperformed TZD in this population.These findings support prioritizing SGLT2i in overweight patients with T2DM and NAFLD, though long-term, large-scale randomized trials incorporating imaging and histology are needed to confirm durability and clinical relevance.PROSPERO registered number is CRD420251130720.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.019 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.034 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".