SUN-222 Pioglitazone: An Underutilized Treatment of Diabetes Concurrent With NASH

Abstract T.A. Alomar: None. A. Joshi: None. E. Ponce: None. D.F. Kaune: None. E. Fraser: None. S. Alomar: None. M. Hazin: None. Introduction: Non-alcoholic steatohepatitis (NASH) and diabetes (DM) are two closely linked conditions that have been shown to be successfully treated with both glitazones (TZDs) and GLP-1 agonists. However, GLP-1 agonists are often prohibitively expensive, especially for many underserved and uninsured patients. Both of these drugs are the preferred first-line treatment for NASH concurrent with DM according to the 2023 American Diabetes Association (ADA) guidelines. In this study, we examined the prescribing patterns of TZDs and GLP-1 agonists and surveyed providers to understand their hesitancy in prescribing TZDs. Methods: Medical records at a low income/uninsured clinic were analyzed. Patient records with a diagnosis of DM, NASH, and DM concurrent with NASH were extracted using ICD-10 codes, along with prescribed medications. Furthermore, a survey of primary care, GI/hepatology, and endocrinology providers associated with the free clinic was conducted. The survey included questions on prescribing patterns, and provider attitudes regarding the treatment of DM and NASH. Results: 1019 patient records were extracted. 57 patients had a diagnosis of both DM and NASH. Only 2/57 patients had been prescribed pioglitazone and 4/57 patients had been prescribed GLP-1 agonists. Survey results yielded 23 responses. Metformin (90%) and insulin (45%) were the most frequent medications used to treat DM, whereas lifestyle changes (70%) and GLP-1 agonists (60%) were the most popular treatments for NASH. For DM concurrent with NASH, the most popular treatments were metformin (89%) and GLP-1 agonists (74%). Only 11% of providers reported using pioglitazone to treat DM concurrent with NASH. 70% of providers stated they were not aware of the most recent ADA recommendations. 60% of physicians were most concerned about side effects of pioglitazone, specifically edema and heart failure. Discussion: Our study found that only a small handful (3%) of our population of uninsured patients with NASH concurrent with DM were prescribed TZDs. Even though providers indicated they would rather use GLP-1 agonists, patients were not prescribed these either, likely due to their prohibitive costs. Doctors were unaware of the ADA guidelines and overly concerned with edema as a side effect. Meta-analyses indicate that TZDs are associated with an increased risk of edema and heart failure, but they reduce the risk of heart attack and have no effect on all cause mortality in patients with cardiovascular disease. Given that TZDs do not increase mortality, reverse hepatic fibrosis, and are cheaper than GLP-1 agonists, increased awareness for their use in the treatment of concurrent DM and NASH is needed. Sunday, June 2, 2024