Biopsy-proven NASH in diabetic patients still remaining treatment challenge, as in non-diabetic patients with NASH the use of either Vitamin E or Pioglitazone is shown to be safe & effective according to AASLD guidelines.
It is in the same way that in non-diabetics, controlling the weight and the serum levels of glucosa as much stick as possible
Recent literature suggests that, along with standard treatment, proper nutrition, probiotics, and other ways of regulating gut microbiome could help.
Some literature:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323444/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812493/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229517/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719124/
http://www.ncbi.nlm.nih.gov/pubmed/25310763
http://www.ncbi.nlm.nih.gov/pubmed/23055155
http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004559
http://www.hindawi.com/journals/bmri/2015/979515/
Best regards,
Jan
Controlling daily sugar/calorie intake and avoiding fructose, since in a hypercaloric diet fructose substantially contributes to hepatic lipogenesis.
http://www.ncbi.nlm.nih.gov/pubmed/25514388
as a diabetes specialist we have been limited in medication usage for NASH patients.
In the past Actos was a good choice. But insulin therapies and GLP-1s are currently used as well in my NASH patients.
There is a recent paper evaluating liraglutide vs placebo in biopsy proven steatohepatitis and it also showed a decrease in fibrosis index and progression rates, so the only two pharmacologic interventions that have proven efficacy are pioglitazone and liraglutide.
https://www.ncbi.nlm.nih.gov/pubmed/26608256
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