Effect of Dapagliflozin on Liver Fat, Liver Stiffness, and Visceral Adiposity in Patients with Type 2 Diabetes Mellitus and MASLD: An Open-Label Study from a Tertiary Care Centre

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in individuals with type 2 diabetes mellitus (T2DM). This study evaluated the effect of dapagliflozin on liver fat, liver stiffness, and visceral adiposity in patients with T2DM and MASLD. Methods: This was a single-arm, prospective, open-label interventional study with a paired design. Sixty-three patients with T2DM and moderate-to-severe hepatic steatosis on ultrasonography received dapagliflozin 10 mg daily for six months. Liver fat by dual-echo-magnetic resonance imaging (MRI), liver stiffness measurement (LSM) by fibroscan, and visceral adipose tissue (VAT) by dual X-ray absorptiometry were assessed at baseline and after six months. Response to therapy was defined as >10% decrease in liver fat and >15% decrease in LSM, respectively (Responders). Multivariable logistic regression analysis was performed to identify predictors of response with respect to change in liver fat and LSM. Results: After six months, mean weight decreased by 2.55 kg (3.23%) and HbA1c by 0.84%. MRI-liver fat percentage, LSM, and VAT volume declined by 2.7%, 0.85kPa, and 472 cm 3 , respectively ( P < 0.001 for all). Change in VAT mass ( r = 0.546) and volume ( r = 0.437) correlated with change in liver fat, and change in aspartate aminotransferase (AST) correlated with change in LSM ( r = 0.351). Sixteen patients (25.4%) and 33 patients (52.4%) met the criteria for responders for liver fat and LSM, respectively. Baseline liver fat and LSM were independent predictors of decrease in liver fat and LSM, respectively in responders. Conclusion: Dapagliflozin significantly reduced liver fat, liver stiffness, and visceral adiposity in patients with T2DM and MASLD.