Drug treatment and type 2 diabetes: the impact of liver disease

Although most liver diseases can occur coincidentally and sporadically with diabetes, non‐alcoholic fatty liver disease (NAFLD) is frequently associated with insulin resistance and overweight, and occurs commonly with type 2 diabetes. Interestingly, NAFLD is not only regarded as a hepatic component of the metabolic syndrome, but also as an independent risk factor and a marker for increase in cardiovascular disease (CVD). Significantly, NAFLD is associated with an increased risk of all‐cause death and predicts future CVD events independently of age, sex, LDL‐cholesterol, smoking and the cluster of features of the metabolic syndrome. Although there was initial concern about drug toxicity with NAFLD, increasing evidence is suggesting that commonly used drugs such as metformin, statins and antihypertensives are probably safe and the glitazone group of drugs may even confer a therapeutic benefit and improve features of NAFLD. Certain sulphonylurea drugs and acarbose may cause an increase in liver enzymes but rarely do these drugs cause overt liver disease. In this review we have focused on the safety and therapeutic impact of thiazolidinediones (TZDs), statins and renin‐angiotensin inhibitors in NAFLD as this is by far the most common liver disease in type 2 diabetes. We also discuss drug‐induced liver toxicity and drug safety in liver disease relevant to diabetes treatment. Copyright © 2007 John Wiley & Sons.