A Drug Cure for a Diabetes Complication

Patient Expert
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A drug that many people with diabetes already use to manage their blood glucose can also reverse a common and serious complication of diabetes, according to a new study. The drug is liraglutide, marketed as Victoza.

The complication is non-alcoholic steatohepatitis, or NASH, which is inflammation of the liver that a buildup of fat in the liver causes. Non-alcoholic fatty liver disease, or NAFLD, which half to 70 percent of all people with type 2 diabetes have, can lead to NASH.

My Story

NASH can be fatal. My late wife, Catherine, who had type 2 diabetes died of its complications in March 2007. I also have type 2 diabetes, and in 2005 a sonogram confirmed that I had NAFLD. I was able to reverse it by losing a lot of weight and by doing much more exercise, the two lifestyle changes that earlier studies showed can reverse it.

Until now, these two changes have been the mainstays of the treatment for NAFLD. But they are difficult to make. Worse, no good study had shown that any drug was both safe and effective, according to “A Meta-Analysis of Randomized Trials for the Treatment of Nonalcoholic Fatty Liver Disease,” which the journal Hepatology, published five years ago.

The Study’s High Standards

But now a well-designed study showed that liraglutide reversed NASH in 39 percent of the subjects compared with just 9 percent in the placebo group. This 48 week study of 52 people in four UK centers was a double-blinded, randomized, placebo-controlled trial reported in one of the oldest, best known, and most prestigious medical journals in the world.

The Lancet published the study, “Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis,” on November 19. While only the abstract is free online, the corresponding author, Professor Philip Newsome, kindly sent me the full-text.

This study does meet the highest generally accepted professional standards, as Steven Bratman, M.D., cogently explains in “Double-Blind Studies.” Yet I have some concern about possible conflicts of interest of some of the authors.

Conflicts of Interest?

Unlike some lesser journals, at least The Lancet requires interests to be divulged. In this case, the article states that three of the 16 named authors, including Professor Newsome, received grants or honoraria from Novo Nordisk, the company that developed and markets liraglutide as Victoza. Novo Nordisk also provided the drug free, which is a rather common practice.

Liraglutide is one of the three non-insulin injectable drugs marketed here in the class called GLP-1 agonists. The others are exenatide, which AstraZeneca markets as Bydureon and Byetta, and dulaglutide, which Eli Lilly markets as Trulicity. Since Professor Newsome and his colleagues found that liraglutide is so effective against NASH, I naturally wanted to know if he thought that exenatide and dulaglutide might offer the same benefit.

“Do you think,” I wrote Professor Newsome a week ago, “that liraglutide might be more efficacious that other GLP-1 agonists? I would appreciate a short comment for my review article.” But I have yet to hear back from him.

What About Exenatide and D ulaglutide**?**

In any case, I wouldn’t be surprised if exenatide and dulaglutide prove to be just as effective against NASH as liraglutide. In my own case I always attributed reversing my fatty liver to weight loss and to exercise. But just after I learned that I had fatty liver disease I started taking Byetta and took it for about two years. I know that it made it possible for me to manage my blood glucose better as well as to lose more than 150 pounds and then found exercise to be easier. Now, I think that it’s quite possible that this drug also reversed my fatty liver.

It could well be that each of these non-insulin injectable drugs offer all three big advantages for those of us who have type 2 diabetes.

See more of my articles about how to manage diabetes:

Fatty Liver

Fatty Liver and Exercise

Diabetes Remission by Losing Weight

Walking Can Reverse Fatty Liver Disease