Introduction: Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) is a common problem occurring in association with obesity and Type 2 Diabetes mellitus (T2DM). There has been anecdotal report of the efficacy of Sodium glucose cotransporter 2 inhibitors (SGLT2Is) in improving liver function parameters in those with concomitant T2DM and NAFLD/NASH. The aim of this study was to systematically evaluate the evidence of SGLT2Is in improving liver function parameters in T2DM patients with NAFLD taking into consideration the risks of random error based on trial sequential analysis (TSA). We also perform meta-analysis based on random-effects model. Methods: A systematic literature search was performed through 3 databases, which are Medline, Cochrane and Embase from inception to 20 October 2018. Primary outcome for meta-analyses was the changes of hepatic enzymes levels (alanine transaminase, aspartate transaminase and gamma-glutamyl transpeptidase). We also performed meta-analysis on changes in insulin resistance, glycaemic and lipid parameters with the use of SGLT2Is as a secondary objective. Results: At last, 8 eligible randomised controlled studies were eligible for analysis. Meta-analysis showed the efficacy of two SLT2Is, dapagliflozin and canagliflozin in reducing these enzymes level. Trial sequential analysis showed that Canagliflozin significantly reduced the GGT level by weighted mean difference =-5.474 (95% CI=-6.289, -4.659) compared to others comparators and the evidence is conclusive. Dapagliflozin also had a statistically significant reduction in HbA1c which is a parameter of glycaemic control and insulin sensitivity-HOMA-IR which is a parameter of insulin sensitivity by a weight mean difference = -0.732 (95% CI=-01.087, -0.378) and -0.804 (95% CI=-1.336, 0.272, respectively. Conclusion: This study indicated that Canagliflozin is effective in improving liver function parameters among patients with diabetes, while dapagliflozin is more effective in improving glycaemic indices and insulin sensitivity.

Introduction: Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) is a common problem occurring in association with obesity and Type 2 Diabetes mellitus (T2DM). There has been anecdotal report of the efficacy of Sodium glucose cotransporter 2 inhibitors (SGLT2Is) in imp...