With the global rise of metabolic dysfunction-associated steatotic liver disease (MASLD) that can lead to metabolic dysfunction-associated steatohepatitis (MASH), there are concerns about the public health and financial repercussions of a growing population developing end-stage liver disease. While numerous studies are being conducted to identify treatments for MASLD and MASH, it is still important to assess how existing diabetes medications affect MASLD, since these medications are readily available and have proven effective in other facets of metabolic syndrome. This systematic review evaluates the effects of five classes of diabetes medications, specifically sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1), dipeptidyl peptidase-4 inhibitors (DPP-4i), metformin, and statins, on MASLD.

We used the Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) by vibration-controlled transient elastography as non-invasive methods for quantifying hepatic fibrosis and steatosis. The literature search was completed on May 1, 2024 using four databases, and 38 studies were included in this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Among the studies, SGLT2i and GLP-1 led to statistically significant reductions in the LSM and CAP, liver enzymes, body mass index, and hemoglobin A1c. There was less literature available for DPP-4i, metformin, and statins, making it difficult to draw conclusions about their effects on MASLD.

This review highlights the need for more trials for each of these five classes of medications, especially trials that incorporate non-invasive testing, to evaluate their effects on MASLD and MASH.