| Abstract: |
Insulin resistance is an integral part of the underlying pathophysiology in most patients with nonalcoholic fatty liver disease (NAFLD), a chronic liver disease that can lead to cirrhosis and liver cancer. This article reviews the current literature on the use of insulin-sensitizing agents in the treatment of patients with NAFLD, particularly in those patients with the more severe form known as nonalcoholic steatohepatitis (NASH). The authors review the use of two major insulin-sensitizing agents: the thiazolidinediones and metformin (the only available biguanide). Thiazolidinedione administration in human NAFLD has been shown to decrease hepatic fat by several different measures and to decrease evidence of cellular injury, but it has also been associated with increased peripheral fat and weight gain. In contrast, metformin has been shown to improve biochemical markers without weight gain, but with more variable improvement in histology. Neither agent has current FDA approval for use in NAFLD, but existing studies provide hope for the benefits of incorporating these medications into NAFLD management strategies in selected patients. In addition, most of the studies do not determine the relative contribution of lifestyle changes compared with drug therapy, which can confound the results. 4 figures. 1 table. 61 references. |