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Insulin resistance is a key factor in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes. Obeticholic acid (OCA) is a semisynthetic human bile acid that regulates glucose and lipid metabolism. Might OCA improve insulin sensitivity in patients with type 2 diabetes and NAFLD? This question was explored in a recent double-blind, proof-of-concept study.
Investigators randomized 64 patients to receive 25 mg of OCA, 50 mg of OCA, or placebo daily for 6 weeks. Insulin sensitivity (primary outcome) was measured at baseline and after 6 weeks of therapy using a two-stage hyperinsulinemic-euglycemic insulin clamp. Secondary outcomes of markers of liver injury and fibrosis were measured based on a noninvasive f…