Diabetes Obes MetabLiver & NASHMeta-AnalysisDecember 1, 2025

Efficacy and safety of liraglutide in non-alcoholic fatty liver disease with or without type 2 diabetes: A systematic review and meta-analysis.

Kong W, Fang B, Xing W

Key Finding

Liraglutide helped people with fatty liver disease lose weight (BMI improvement with 85% standardized effect) and improve liver function markers like GGT, but came with mostly manageable stomach side effects.

What This Study Found

This study is like having a detective investigate whether liraglutide - a diabetes drug that's also used for weight loss - can help people with fatty liver disease (NAFLD). The researchers gathered evidence from 8 clinical trials involving 478 people, some with diabetes and some without. Think of fatty liver disease like a liver that's been stuffed with too much fat - it's sluggish and inflamed, struggling to do its job properly. The study found that liraglutide acts like a helpful coach for these struggling livers. It consistently helped people lose weight and improved their blood sugar control, while also reducing GGT levels - a key marker that tells us how much the liver is being damaged. The drug was especially helpful for people who had both fatty liver disease AND diabetes, also improving their ALT levels (another liver damage marker) and triglycerides (blood fats). However, like many effective treatments, liraglutide came with a trade-off - more stomach problems like nausea and diarrhea, though these were usually temporary and manageable.

Statistics Decoded

SMD of -0.85 for BMI means liraglutide had a large, consistent effect on weight loss across all studies - this is considered a strong effect size. The 95% confidence interval of -1.04 to -0.66 means we're pretty sure the real benefit falls somewhere in this range, and it doesn't cross zero, so this wasn't just luck. The GGT improvement (SMD: -1.10) with p<0.00001 means there's less than a 1 in 100,000 chance this liver improvement happened by coincidence - like winning the lottery odds that this was random. For ALT and triglycerides, the benefits were more modest (SMD around -0.44 and -1.08 respectively) but still meaningful. The fact that HbA1c wasn't significantly improved (confidence interval crossed zero: -0.39 to 0.67) means the blood sugar benefits were inconsistent across studies.

Why This Matters

This matters because fatty liver disease affects up to 25% of adults worldwide and can progress to serious liver damage, yet treatment options are limited - this gives doctors evidence-based ammunition to help these patients. For the millions of people with both diabetes and fatty liver disease, liraglutide could be a two-birds-one-stone solution that tackles both conditions simultaneously.

Original Abstract

To comprehensively assess the efficacy and safety of liraglutide on metabolic and hepatic outcomes in patients with non-alcoholic fatty liver disease (NAFLD), with or without type 2 diabetes mellitus (T2DM), based on randomised controlled trials (RCTs). Electronic databases (PubMed, Web of Science, Cochrane Library and Embase) were systematically searched for randomised RCTs evaluating liraglutide in the treatment of NAFLD. Outcome measures included body mass index (BMI), glycated haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and adverse events (AEs). Eight RCTs (with an overall moderate risk of bias as assessed by the Cochrane Risk of Bias tool) involving 478 participants were included in the analysis. The meta-analysis results demonstrated that liraglutide significantly improved BMI (standardised mean difference [SMD]: -0.85; 95% confidence interval [CI]: -1.04 to -0.66), FPG (SMD: -1.22; 95% CI: -1.97 to -0.46), and GGT (SMD: -1.10; 95% CI: -1.48 to -0.72; p < 0.00001) in patients with NAFLD, regardless of T2DM comorbidity. Furthermore, liraglutide showed positive effects on ALT (SMD: -0.44; 95% CI: -0.80 to -0.08) and TG (SMD: -1.08; 95% CI: -1.97 to -0.19) specifically in patients with NAFLD comorbid with T2DM. However, the effect of liraglutide on HbA1c was not statistically significant (SMD: 0.14; 95% CI: -0.39 to 0.67). Regarding safety, liraglutide was associated with a higher incidence of adverse events, primarily gastrointestinal disorders such as nausea and diarrhoea, though these were mostly transient. Liraglutide demonstrates beneficial effects on BMI, FPG and GGT in patients with NAFLD with or without comorbid T2DM. It also shows positive effects on ALT and TG in patients with NAFLD and T2DM. While the treatment was associated with a higher burden of mostly manageable gastrointestinal adverse events, the findings of this study warrant further validation in prospective high-quality studies.