Effect of empagliflozin on liver function in type 2 diabetes: A systematic review and meta-analysis of randomized trials

Zahra Rafat, Kourosh Delpasand, Davoud Roostaei


Many reports are indicating the blood sugar-lowering potential of empagliflozin in type 2 diabetes mellitus and its anti-lipogenesis effects in the liver, as studied in mice models; while few clinical trials have evaluated its effect on liver fat content and liver function. This study aimed to evaluate the effect of empagliflozin on the treatment of non‐alcoholic fatty liver disease in type 2 diabetes mellitus patients. Scopus, Cochran Library, PubMed, and Web of Science databases were searched from 1990 to 2022 with reference checking and citation searching to identify additional studies. The inclusion criteria for studies included were the evaluation of patients with non‐alcoholic fatty liver disease and type 2 diabetes being treated with empagliflozin for 24 weeks. Our interest outcomes were Liver fat, Alanine transaminase (ALT), and Aspartate transaminase (AST). Data analysis random effect size model was used for pooling data to calculate mean differences in RevMan Version 5.3. I2 was used to evaluate heterogeneity. Three clinical trial studies were included with 2344 patients. In pooled ALT mean difference evaluation within 24 weeks of studies, there was a significant difference between subjects receiving empagliflozin versus controls (MD = -6.6 CI95% (-10.27 to -3.73; P = 0.06; I2 = 99%). In the case of AST (MD = -9.06 CI95% (-20.45 to 2.34; P = 0.12; I2 = 98%) and Liver fat (MD = -4.46 CI95% (-10.06 to 0.77; P = 0.09; I2 = 98%), there was not any significant difference between subjects receiving empagliflozin versus controls. While empagliflozin seems to be effective in lowering ALT levels; further studies are needed to confirm its efficacy in lowering liver fat.


Non‐alcoholic fatty liver disease; Empagliflozin; Type 2 diabetes mellitus

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