Follow-up of NAFLD Patients With MRI-PDFF

This study aims to define

• The effects of PTX, Empagliflozin as an example of SGLT-2 inhibitors and UDCA on liver biomarkers and liver steatosis in type 2 diabetic patients.
• Studying PTX, Empagliflozin as an example of SGLT-2 inhibitors and UDCA efficacy and safety as add-on therapy in type 2 diabetic patients.

Inclusion criteria

• Patients who are willing to participate in this study
• Adults aged ≥ 18 years old presented at the clinic with a confirmed diagnosis of T2DM who are on sulfonylurea for the last 6 months at least and diagnosed with NAFLD.

Exclusion criteria

• • Patients who refused to participate in this trial

• Patients diagnosed with Type 1 diabetes
• Previous history of alcohol intake
• history of recurrent attacks of ketoacidosis in a diabetic patient
• Type 2 diabetic patient with kidney dysfunction (estimated eGFR below 60ml/min/1.73m2 or CrCl below 60ml/min) or on dialysis
• Previous history of taking medication that may alter either drug efficacy (eg, corticosteroids, oral contraceptives, and thiazide diuretics)
• Evidence of another liver disease (viral hepatitis, drug-induced liver disease, autoimmune hepatitis)
• Lactating/pregnant female or children ≤ 18
• Any contraindication for Empagliflozin including:

• History of recurrent attacks of UTI or Genital infection in females
• History of recurrent foot injuries or infections
• Type 2 diabetic patient with CV disease especially NYHA classes III/ IV
• Immunocompromised patients or with a history of inflammatory, immunological, or malignant diseases.
• Any contraindication for PTX including:

• Hypersensitivity to PTX
• Patients with peptic ulcer disease or tendency for bleeding
• Any contraindication for UDCA including:

• Hypersensitivity to UDCA
• Patients with biliary disease or hepatobiliary disease (ascites, jaundice)
• Patients with hepatic encephalopathy or gallstone pancreatitis