Impact of empagliflozin as add-on to metformin vs metformin continuation on MASLD progression in type 2 diabetes: The IMAGIN Study
Abstract
BACKGROUND AND AIM
MASLD is the leading cause of chronic liver disease. This study evaluated the effects of empagliflozin + metformin (combination therapy) versus metformin monotherapy (control) on MASLD progression in type 2 diabetes (T2D) patients.
METHODS AND RESULTS
This single-center, prospective observational study included SGLT2i-naïve adults with metformin-treated T2D, eGFR ≥45 mL/min/1.73 m2, and MASLD. FibroScan®/CAP, biochemical, and anthropometric assessments were conducted at baseline, 6 months, and 12 months. Eighty-eight patients were enrolled (47 controls, 41 combination therapy). At 12 months, combination therapy led to significantly greater improvements in BMI, ALT, HbA1c, CAP, and liver stiffness (p < 0.05). It was associated with higher odds of steatosis (OR 9.79, p < 0.001) and fibrosis improvement (OR 5.31, p = 0.001). Changes in BMI and HbA1c did not correlate with CAP or liver stiffness improvement. Exploratory miRNA analysis (n = 17) suggested potential moderate negative correlations between baseline miR-122 and steatosis improvement (r = -0.4820, p = 0.050) and miR-21 and fibrosis improvement (r = -0.5410, p = 0.014).
CONCLUSIONS
Empagliflozin + metformin improved liver parameters more effectively than metformin alone in T2D patients with MASLD. Baseline miR-122 and miR-21 may serve as potential biomarkers for steatosis and fibrosis improvement, respectively.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 17 participants or records.
Read the paper
Related studies
- The Role of AMPK Activation for Cardioprotection in Doxorubicin-Induced Cardiotoxicity
- Hypoglycemic medicines in the treatment of Alzheimer’s disease: Pathophysiological links between AD and glucose metabolism
- Isorhamnetin Reduces Glucose Level, Inflammation, and Oxidative Stress in High-Fat Diet/Streptozotocin Diabetic Mice Model
- Modulating Sirtuin Biology and Nicotinamide Adenine Diphosphate Metabolism in Cardiovascular Disease—From Bench to Bedside
- Characterization of the SGLT2 Interaction Network and Its Regulation by SGLT2 Inhibitors: A Bioinformatic Analysis
- Early Treatment with Empagliflozin and GABA Improves β-Cell Mass and Glucose Tolerance in Streptozotocin-Treated Mice
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.