The diabetes drug called liraglutide, marketed as Victoza, can reverse a common and serious complication of diabetes, according to a new study. This is good news for anyone who is already taking it or Byetta or Bydureon to manage blood glucose.
This complication goes by the mouthful of a name “non-alcoholic steatohepatitis,” or NASH, which is inflammation of the liver, which 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.
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 never heard back from him.
What About Exenatide and Dulaglutide?
In any case, I wouldn’t be surprised if exenatide (Byetta and Bydureon) and dulaglutide (Trulicity) prove to be just as effective against NASH as liraglutide (Victoza). 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.
This article is based on an earlier version of my article published by HealthCentral.
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Thanks David. I’m in Canada (which may make things even more difficult potentially). But I have no insurance, pay out of pocket so maybe that will make a difference. I’ll see how much weight I lose until my endo appointment in May. Thanks.
Hi David, I found your website years and years ago, and refound you when doing a search on chana dal. I was profoundly impressed with your very scientific approach to managing your type 2 diabetes. Yours was the best blog on the subject that I could find.
Maybe you can answer this: I do not have diabetes but do have some fatty liver issues because I am 30 pounds overweight. Thyroid tanked with menopause >>> weight gain. Thyroid now well treated after a two year struggle with endocrinologist, and weight is slowly coming off. As in S.L.O.W. It was 2 pounds per month last three months of 2015. I’m now working at making it 1 pound per week. Too early to say if I need to make further adjustments. Tweaking the diet because yes, I was coasting to metabolic syndrome. HbA1c went from 5.2 in 2010 to 5.8 in 2015. Also using a glucosemeter for the past year to determine responses to various foods. (For example right now glucose is 6.8 after having a duck egg and browned wedges of one medium previously boiled potato for breakfast. So clearly not getting a diabetic type response. Rarely blood glucose now goes to low 7s after a meal. Fasting is a bit higher than I’d like (mid 5s) but during the day several hours after a low carb meal, glucose goes to mid 4s then back up to mid 5s from endogenous production.
Do you think I could convince my endocrinologist to prescribe low dose once a day Byetta? I don’t have carb cravings, but have to watch that I don’t overeat especially the last meal of the day. It’s one of those situations where appetite starts after beginning to eat! I’m working hard at not being in a position to eat seconds which is what caused the ballooning over the previous years. I”m actually amazed I didn’t end up gaining a lot more weight considering! I didn’t have a weigh scale at home but do now. True that we like to weigh when we are losing but don’t when we know we are gaining. 😉
I’ve gotten very organized with grocery shopping and food prep. Adapting from cooking for a family and then going through ’empty nest syndrome’ which I really didn’t think would happen but it did, took quite a lot of effort. If I can get the liver fat down at some reasonable pace, that would probably help with the efficacy of the thyroid replacement. For that reason alone I think I could lobby my endocrinologist.
But then afterwards, if I am using let’s say 5 mcg Byetta before supper, would I have to monitor blood glucose more intensely? I wouldn’t want to use anything higher than that because I want to find out first what the dose response may be. And given what I’ve read on your website, that people taking larger doses then stopping get into mega carb cravings and gain weight again…… nah. Just want to tweak and discover if it makes any difference.
If you live in the U.S., Gabi, you will almost certainly not be able to prescribe Victoza, Byetta, or any of the GLP-1 receptor agonists. The only diabetes drug that physicians sometimes prescribe for people with pre-diabetes like you is metformin. While even metformin isn’t officially approved for people who don’t have full-fledged diabetes, some physicians do prescribe it off-label.
Hmm, the “safety..” link you set in the response to my first comment doesn’t work….
Sorry about my use of “extreme”. It was not intended judgmentally. That and “necessary” are not mutually exclusive. (Example: flooring the car to avoid an oncoming train is extreme, but may also be necessary.) Be that as it may, I offer “rigorous” as a replacement.
Sorry for messing up the “safety” link, Bill. I corrected it just now and here it is:
My “rigorous” measures to manage my diabetes came after years of not being rigorous enough to get either my blood glucose or weight down. When I started taking Byetta, which was the first of the GLP-1 agonists, I figured that it was my last chance to do what I knew I needed to do. So I took that opportunity and it turned out even better than I ever would have dared to dream.
Gotta say, I have had fatty liver diagnosis longer than the type 2 diabetes – and this is at least 20 years, right after the hypothyroid diagnosis. In March 2014 I stopped eating gluten. My blood work in April 2015 showed that the liver enzymes have come down, and only 1 is just slightly elevated, almost normal.
This is very encouraging, but not so encouraging are warnings on Drugwatch.com, warning about scary side effects–pancreatitis, pancreatic cancer, thyroid cancer. (But perhaps that website has a conflict of interest. And I have no idea of their track record. They may be professional alarmists!) Any thoughts?
Very interesting the story of your personal history! I had always wondered what motivated you to take such extreme measures in your own case.
Also, I note that Dr, Bernstein advocates using Victoza and the other incretin mimetics off-label to counter carb cravings–in fact, because of Victoza’s once-a-day administration, it’s his favorite for that purpose, although the effect may be transitory.
Thanks for asking, Bill. Regarding the supposed side effects I do have thoughts and I wrote about them here:
The Safety of Diabetes Drugs. Those studies have pretty well reversed the concern over them.
But I hardly know how to start replying about my “extreme measures.” I guess I never thought of them as being extreme. What is necessary for good health can’t be extreme, can it?
Thanks David for this news, very interesting. Do you think the drug marketed as Similitude, not sure I am spelling it right, it was available at the same time Byetta came out and was for type 1 could help with fatty liver? Thanks
You are thinking of Symlin, John. It is used only as an adjunct to insulin injections, and I have never heard that it is particularly helpful in reversing fatty liver disease.
I have had type-1 diabetes for 56 years, controlled by lantus and humalog, and also have a fatty liver with elevated enzymes. Do you think any of the medications you mention could be effectively used by an 80-year-old type-1 diabetic?
Few, if any, doctors would prescribe any of these drugs for someone with type 1 diabetes, George. Sorry!