Thirty adults with type 2 diabetes and MASLD took empagliflozin 25 mg daily for 12 weeks alongside usual care. Mean ALT fell from 86.3 to 44.6 U/L and AST from 80.3 to 45.2 U/L. Transient elastography showed hepatic fat (CAP) dropping from 321.8 to 261.3 and liver stiffness from 7.22 to 6.24 kPa, all at P < 0.001.
The direction fits a growing body of evidence: randomized trials and meta-analyses of SGLT2 inhibitors, including E-LIFT, have shown reductions in liver fat on MRI-PDFF and in aminotransferases. This study is much weaker evidence than those trials. It has no control group, only 30 participants, and a 12-week window, so regression to the mean, concurrent weight loss, glycemic improvement, and changes in background therapy or diet could explain much of the effect. The enzyme drop, nearly halving ALT, is unusually large for 12 weeks and warrants caution, as does the very narrow post-treatment variance. Stiffness readings near 6 kPa are also hard to interpret, since fibrosis regression within three months would be remarkable and may reflect reduced inflammation or steatosis-related measurement effects rather than true fibrosis reversal. For adults with diabetes and fatty liver, the practical takeaway is modest: SGLT2 inhibitors are already prescribed for glycemic, cardiac and kidney benefit, and liver improvement may be a welcome bonus to discuss with a clinician. Confirmatory at best, it needs controlled, longer trials with histology or MRI endpoints.