Effect of Pioglitazone Combined with Metformin on Metabolism and Liver Function in Patients with Type 2 Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease

doi:10.3969/j.issn.1674-3245.2025.03.036

Abstract：Objective To observe the effect of pioglitazone combined with metformin on metabolism and liver function in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods Sixty patients with T2DM and NAFLD admitted to Gongli Hospital, Pudong New Area, Shanghai from March 2022 to February 2023 were selected and randomly divided into two groups. The control group (n=30) received oral metformin, while the observation group (n=30) received oral metformin plus pioglitazone for 24 weeks. The clinical efficacy, changes in blood glucose [fasting blood glucose (FBG), postprandial 2-hour blood glucose (2hBG), glycated hemoglobin (HbA1c)], fasting insulin (FINS), insulin resistance index (HOMA-IR), lipid profile [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)], liver function [aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT)], liver steatosis grade, weight, waist circumference, and adverse reactions were compared between the two groups. Results After 24 weeks of treatment, the effective rate of the observation group was higher than that of the control group (90.00% vs. 66.67%), with a statistically significant difference (χ²=4.812, P<0.05). After 24 weeks of treatment, the levels of FBG, 2hBG, HbA1c, FINS, HOMA-IR, TC, TG, and LDL-C in the observation group were lower than those in the control group, while HDL-C was higher, with statistically significant differences (t=6.001, 3.941, 2.055, 2.495, 3.162, 2.089, 2.215, 2.113, 2.098, P<0.05). After 24 weeks of treatment, the levels of AST, ALT, and GGT in the observation group were lower than those in the control group, with statistically significant differences (t=2.150, 2.087, 2.083, P<0.05); the liver steatosis grade in the observation group was better than that in the control group, with a statistically significant difference (P<0.05). At 24 weeks of treatment, there was no statistically significant difference in weight or waist circumference between the two groups (P>0.05), and there was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The combination of pioglitazone and metformin has a significant therapeutic effect on patients with T2DM and NAFLD, which can improve glucose and lipid metabolism and liver function, and has a high safety profile, which is worth further clinical promotion.