Last updated August 16, 2026
Key finding
Liver fat by MRI-PDFF decreased significantly.
This study investigated the effects of combination therapy with pioglitazone and empagliflozin on liver health in type 2 diabetes patients, finding significant reductions in liver fat and stiffness.
Quick read
The essential study design details in one scan.
EvidenceScore™
Moderate
Study type
RCTs
Follow-up
Medium-Term (3–12 mo)
Risk of bias
Some Concerns
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Plain-language summary
A plain-language read of the study’s main message and where it applies.
Study focus
This study investigated the effects of combination therapy with pioglitazone and empagliflozin on liver health in type 2 diabetes patients, finding significant reductions in liver fat and stiffness.
Metabolic dysfunction-associated steatotic liver disease is a common complication in type 2 diabetes, leading to serious health issues. This study highlights a potential treatment strategy that could improve liver health, which is crucial for managing diabetes and preventing further complications.
Limited sample size may affect generalizability. Study duration may not capture long-term effects. Lack of data on other potential confounding factors.
Published in
Publication details and source links for this paper.
Minyoung L, Sukchul H, Yongin C, et al. Combination therapy of pioglitazone and empagliflozin for metabolic dysfunction-associated steatotic liver disease in type 2 diabetes. BMC Medicine. 2025;23:266. doi:10.1186/s12916-025-04017-x
Combination therapy resulted in a 10% reduction in liver fat fraction (p=0.01).
Combination therapy led to a decrease of 5 kPa in liver stiffness (p=0.029).
AST levels decreased by 9 IU/L (p=0.001) and ALT levels decreased by 19 IU/L (p=0.001) after treatment.
Evidence network
Understand where this research contributes within the broader evidence network.
This study contributes evidence to Combination therapy (PIO 15 mg + EMPA 10 mg), Empagliflozin, Pioglitazone and Adiponectin, Change in MRI-proton density fat fraction (MRI-PDFF), Fasting Plasma Glucose (FPG), and 2 more.
This study contributes evidence to
Primary intervention
Combination therapy (PIO 15 mg + EMPA 10 mg)
Primary outcomes
Primary intervention
Intervention and outcome relationships this study adds to the evidence network.
Editorial context
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Evidence network role
This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.
5
Related topics
15
Evidence pairs
878
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Contributes evidence
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Primary evidence
Evidence relationship
Related evidence
Evidence relationship
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Evidence relationship
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Core evidence
The primary outcomes reported in this study.
Combination therapy (PIO 15 mg + EMPA 10 mg) → Adiponectin
Combination therapy (PIO 15 mg + EMPA 10 mg) → Adiponectin
Combination therapy (PIO 15 mg + EMPA 10 mg) → Change in MRI-proton density fat fraction (MRI-PDFF)
Combination therapy (PIO 15 mg + EMPA 10 mg) → Change in MRI-proton density fat fraction (MRI-PDFF)
Combination therapy (PIO 15 mg + EMPA 10 mg) → Fasting Plasma Glucose (FPG)
Combination therapy (PIO 15 mg + EMPA 10 mg) → Fasting Plasma Glucose (FPG)
Combination therapy (PIO 15 mg + EMPA 10 mg) → HbA1c
Combination therapy (PIO 15 mg + EMPA 10 mg) → HbA1c
Combination therapy (PIO 15 mg + EMPA 10 mg) → Liver stiffness measure
Combination therapy (PIO 15 mg + EMPA 10 mg) → Liver stiffness measure
Empagliflozin → Change in MRI-proton density fat fraction (MRI-PDFF)
Empagliflozin → Change in MRI-proton density fat fraction (MRI-PDFF)
Empagliflozin → Fasting Plasma Glucose (FPG)
Empagliflozin → Fasting Plasma Glucose (FPG)
Empagliflozin → Liver stiffness measure
Empagliflozin → Liver stiffness measure
Pioglitazone → Change in MRI-proton density fat fraction (MRI-PDFF)
Pioglitazone → Change in MRI-proton density fat fraction (MRI-PDFF)
Pioglitazone → Fasting Plasma Glucose (FPG)
Pioglitazone → Fasting Plasma Glucose (FPG)
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Relationships organized using the Dediabetes Evidence Intelligence™ framework.
This study contributes to evidence on SGLT2 Inhibitors and HbA1c, Thiazolidinediones and HbA1c.
This study contributes to the evidence on the following intervention-outcome relationships.
Medications
Medications
Curated evidence collections and hubs this study is part of.
All studies measuring HbA1c
Measures HbA1c as a key outcome.
All studies on SGLT2 Inhibitors
Contributes to SGLT2 Inhibitors evidence base.
All studies on Thiazolidinediones
Contributes to Thiazolidinediones evidence base.
Latest published studies
Published within the last 2 years.
Jump to pre-filtered views in Evidence Explorer.
8 results
5 results
8 results
5 results
8 results
Generated from the study's connected evidence using Evidence Intelligence™.
SGLT2 Inhibitors may improve HbA1c.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
HbA1c
EvidenceScore™ Strong | EvidenceScore™ 85.4 | moderate positive | ConsistencyScore™ Consistent | 1 study
Why this answer: This answer is based on 16 supporting studies with consistent results and a positive effect signal.
Limitations
Thiazolidinediones appears to improve HbA1c.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
HbA1c
EvidenceScore™ Strong | EvidenceScore™ 83.8 | strong positive | ConsistencyScore™ Consistent | 1 study
Why this answer: This answer is based on 5 supporting studies with consistent results and a positive effect signal.
Limitations
SGLT2 Inhibitors may improve Fasting Glucose.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
Fasting Plasma Glucose (FPG)
EvidenceScore™ Strong | EvidenceScore™ 79.0 | moderate positive | ConsistencyScore™ Consistent | 1 study
Why this answer: This answer is based on 12 supporting studies with consistent results and a positive effect signal.
Limitations
SGLT2 Inhibitors may improve Adipokine and Angiogenic Markers.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
Adiponectin
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on 8 supporting studies with consistent results and a positive effect signal.
Limitations
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