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In the most recent American Association of Clinical Endocrinology clinical practice guidelines for the diagnosis and management of NAFLD it was recommended to administer pioglitazone (PIO) or glucagon-like peptide 1 receptor (GLP-1R) agonists with proven benefit for patients with T2D and biopsy-proven NASH, while these medications should be considered when there is high probability of having NASH (based on higher plasma aminotransferase levels and non-invasive tests) [40]
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While these medications are generally well tolerated, gastrointestinal side effects such as nausea and constipation are common and have been reported to limit therapy [2, 3, 4]
potential long-term risks include pancreatitis, gallbladder disease, lean muscle loss, and early worsening of diabetic retinopathy, though no confirmed causal links exist beyond 48 weeks of data
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