Dapagliflozin plus pioglitazone improves glycemia and hepatic steatosis markers

This meta-analysis quantifies the additive glycemic and non-invasive hepatic benefits of an oral SGLT2 inhibitor plus thiazolidinedione combination in type 2 diabetes with or without fatty liver disease.

dapagliflozinpioglitazoneSGLT2 inhibitorthiazolidinedionetype 2 diabetesMASLDNAFLDNASHcombination therapymeta-analysishepatic steatosisglycemic control Clinical Practice

Background Information

Improved glycemic and liver outcomes found with combination therapy in T2DM.

This meta-analysis evaluates the effectiveness of dapagliflozin plus pioglitazone in adults with type 2 diabetes mellitus (T2DM), providing insights into metabolic and hepatic outcomes. The combination therapy improved glycemic control by reducing hemoglobin A1c (HbA1c) by -0.49% and showed positive effects on liver fat and steatosis markers. While the findings indicate potential benefits for patients with T2DM and metabolic dysfunction-associated steatotic liver disease (MASLD), caution is advised due to moderate to low certainty evidence and reliance on surrogate endpoints. Dapagliflozin and pioglitazone combination improves glycemic and hepatic outcomes in T2DM with moderate evidence.

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Authors: Joshi S, Samajdar SS, Gupta A, Bhartia M, Lodha S, Bhattacharyya S, Seshadri K, Nagendra L, Unnikrishnan AG, Padhye D, Kopalle LN, Das AK, Lakhani O, Kesavadev J, Joshi A, Das S, Gadia S, Anthuvan T

Citation: Joshi S, Samajdar SS, Gupta A, et al. Dapagliflozin & pioglitazone combination therapy in T2DM with or without MASLD - a systematic review and meta-analysis: PRO-2 study. Frontiers in clinical diabetes and healthcare. 2026;7:1733995. doi:10.3389/fcdhc.2026.1733995

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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