Date of Award

3-1-2020

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Uzma Khan

Department

Community Health Sciences

Abstract

Background: Type 2 diabetic patients tend to have increased tendency of Non-alcoholic fatty liver disease (NAFLD) that may lead to Non-alcoholic steato-hepatitis and cirrhosis. There is also increased risk of cardio-vascular events and hepato-cellular carcinoma in these patients that may result in increased premature mortality. Aims: Till date, there are no approved pharmacotherapies available for NAFLD treatment. Alanine-Aminotransferase (ALT) is a biomarker of liver inflammation. People with elevated transaminase levels, obesity, diabetes, and increasing age are at more risk of developing cirrhosis. By reducing the transaminase levels in diabetic patients, we may slow the progression of liver[1]related morbidity and mortality. Sodium-glucose co-transporter 2 inhibitors (SGLT2-i) are anti[1]diabetic drugs that have shown to reduce ALT levels. We aim to elucidate the effectiveness of SGLT2-i as first or second line drug in the treatment of diabetes with NAFLD in our setup.
Methods: We retrospectively examined the effects of SGLT2-i when included in treatment protocol of diabetic patients having elevated ALT levels. We collected data using validated questionnaire tool from files of 120 T2DM, aged 30 – 60 years; taken out from Health Information and Management System (HIMS) or from the diabetes database; who followed up in Aga Khan University Hospital, adult endocrine clinic, during August 2018 – July 2019. We used Generalized Estimating Equation (GEE) for the analysis of our longitudinal data.
Results: The mean reduction in ALT levels among patients taking 10 mg Empagliflozin was 8.7 IU/L [95% CI -13.0 to -4.4] in females, as compared to patients not taking any SGLT2-i in females, after adjusting for LDL and TG in the model. In the presence of gender, the reduction in mean ALT by SGLT2-i use was observed to have different patterns at different levels.
Conclusions: We observed an average reduction in mean ALT when SGLT2-i was added in standard treatment of diabetic patients having NAFLD. Apart from educating for diet and lifestyle modification at public level, early intervention with SGLT2-i by the clinicians may improve hepatic dysfunction and decrease the morbidity resulting from NAFLD.

First Page

1

Last Page

49

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