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RETROSPECTIVE ANALYSIS OF THE ROLE OF TYPE 2 DIABETES MELLITUS AND THERAPY USING A THIAZOLIDINEDIONE ON THE PRESENCE AND SUBSEQUENT CONTROL OR RESOLUTION OF NONALCOHOLIC STEATOHEPATITIS

A White , M Byrne, T Elliott, E Yoshida
The Divisions of Gastroenterology and Endocrinology, the University of British Columbia, Vancouver, British Columbia

BACKGROUND: Nonalcoholic steatohepatitis (NASH) represents a late stage in a continuum of changes to the liver from fatty infiltration fibrosis and on occasion cirrhosis with hepatic failure. Several associations have been made with the development of NASH including type 2 diabetes (T2DM), dyslipidemia, obesity and the combination known as the metabolic syndrome. This study investigates the utility of the TZD class of oral hypoglycemics in NASH management.
METHODS: Retrospective chart review of patients with a diagnosis of T2DM, found to have an elevation of AST and a history compatible with NASH who were treated with a TZD within the time period of January 2000 to March 2006. Baseline and serial HbA1C and AST values were evaluated with secondary review of lipid profiles and adverse events.
RESULTS: 19 patients were identified for review. Baseline AST averaged 64.7 U/L. This value fell to 51.2 U/L (P<0.05). HbA1C values, however, did not differ significantly from baseline. There was a positive correlation between elevated HbA1C and elevation of AST (P<0.05). HDL and HDL/Cholesterol ratio, as a secondary endpoint, showed a negative correlation with AST. There were no significant adverse events reported.
CONCLUSIONS: A smaller cohort of patients was available for review than expected. This may be due to a "self-selection" whereby patients are not initiated with TZD therapy in diabetes management due to baseline transaminase elevation. However, this small group did show that there was no worsening of transaminase levels despite the use of AST. It is difficult to conclude that TZD therapy in this setting had a positive impact, underscoring the need for future prospective randomized studies in patients with T2DM and NASH.

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