{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:07:31Z","timestamp":1757311651474,"version":"3.41.2"},"reference-count":24,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T00:00:00Z","timestamp":1701216000000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","award":["KL2 TR002554"],"award-info":[{"award-number":["KL2 TR002554"]}],"id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2023,11,1]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Metabolic dysfunction-associated steatohepatitis (MASH) is highly prevalent in type 2 diabetes (T2D). Pioglitazone and glucagon-like peptide-1 receptor agonists (GLP-1RA) are medications used in T2D that can resolve MASH and should be considered in all patients with T2D and MASH. We assessed prescription rates of evidence-based T2D pharmacotherapy (EBP) in MASH, and ascertained racial\/ethnic disparities in prescribing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>We conducted a cross-sectional study on patients in Duke University Health System with diagnosis codes for T2D and MASH between January 2019 and January 2021. Only patients with \u22651 primary care or endocrinology encounter were included. The primary outcome was EBP, defined as \u22651 prescription for pioglitazone and\/or a GLP-1RA during the study period. A multivariable logistic regression model was used to examine the primary outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 847 patients with T2D and MASH were identified; mean age was 59.7 (SD 12) years, 61.9% (n=524) were female, and 11.9% (n=101) and 4.6% (n=39) were of Black race and Latino\/a\/x ethnicity, respectively. EBP was prescribed in 34.8% (n=295). No significant differences were noted in the rates of EBP use across racial\/ethnic groups (Latino\/a\/x vs White patients: adjusted OR (aOR) 1.82, 95%\u2009CI 0.78 to 4.28; Black vs White patients: aOR 0.76, 95% CI 0.44 to 1.33, p=0.20).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>EBP prescriptions, especially pioglitazone, are low in patients with T2D and MASH, regardless of race\/ethnicity. These data underscore the need for interventions to close the gap between current and evidence-based care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2023-003763","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T20:50:11Z","timestamp":1701291011000},"page":"e003763","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Prescribing of evidence-based diabetes pharmacotherapy in patients with metabolic dysfunction-associated steatohepatitis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0690-1526","authenticated-orcid":false,"given":"Anastasia-Stefania","family":"Alexopoulos","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA"},{"name":"Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA"},{"name":"Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Parish","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maren","family":"Olsen","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA"},{"name":"Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan C","family":"Batch","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA"},{"name":"Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Moylan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Duke University, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J","family":"Crowley","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA"},{"name":"Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA"},{"name":"Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"key":"2025073113175734000_11.6.e003763.1","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1097\/HEP.0000000000000520","article-title":"A multi-society Delphi consensus statement on new fatty liver disease nomenclature","volume":"78","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"2025073113175734000_11.6.e003763.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.06.021"},{"key":"2025073113175734000_11.6.e003763.3","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/cld.948","article-title":"Racial disparities in diagnosis and prognosis of nonalcoholic fatty liver disease","volume":"16","author":"Samji","year":"2020","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"2025073113175734000_11.6.e003763.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2022.03.010"},{"key":"2025073113175734000_11.6.e003763.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa060326"},{"key":"2025073113175734000_11.6.e003763.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907929"},{"key":"2025073113175734000_11.6.e003763.7","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1774"},{"key":"2025073113175734000_11.6.e003763.8","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.06.047"},{"key":"2025073113175734000_11.6.e003763.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00803-X"},{"key":"2025073113175734000_11.6.e003763.10","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1056\/NEJMoa2028395","article-title":"A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis","volume":"384","author":"Newsome","year":"2021","journal-title":"N Engl J Med"},{"key":"2025073113175734000_11.6.e003763.11","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2021.635556","article-title":"Effect of SGLT2 inhibitors on type 2 diabetes mellitus with non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials","volume":"12","author":"Wei","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2025073113175734000_11.6.e003763.12","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.2337\/dc23-S004","article-title":"4. comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"2025073113175734000_11.6.e003763.13","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"2025073113175734000_11.6.e003763.14","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1053\/j.gastro.2021.07.049","article-title":"Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease","volume":"161","author":"Kanwal","year":"2021","journal-title":"Gastroenterology"},{"key":"2025073113175734000_11.6.e003763.15","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21178"},{"key":"2025073113175734000_11.6.e003763.16","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.453"},{"key":"2025073113175734000_11.6.e003763.17","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.35792","article-title":"Comparison of diabetes medications used by adults with commercial insurance vs medicare advantage, 2016 to 2019","volume":"4","author":"McCoy","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025073113175734000_11.6.e003763.18","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29367"},{"key":"2025073113175734000_11.6.e003763.19","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1001\/jamainternmed.2016.9607","article-title":"Thiazolidinediones and advanced liver fibrosis in nonalcoholic steatohepatitis: a meta-analysis","volume":"177","author":"Musso","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2025073113175734000_11.6.e003763.20","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/13543784.2020.1704731","article-title":"Trends in pioglitazone use among U.S. adults with type 2 diabetes and suspected nonalcoholic fatty liver disease","volume":"29","author":"Le","year":"2020","journal-title":"Expert Opin Investig Drugs"},{"key":"2025073113175734000_11.6.e003763.21","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1007\/s13300-017-0273-4","article-title":"Pioglitazone and the risk of bladder cancer: a meta-analysis","volume":"8","author":"Filipova","year":"2017","journal-title":"Diabetes Ther"},{"key":"2025073113175734000_11.6.e003763.22","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.2337\/dc23-S003","article-title":"3. Prevention or delay of type 2 diabetes and associated comorbidities: standards of care in diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"2025073113175734000_11.6.e003763.23","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1053\/j.gastro.2021.04.074","article-title":"Preparing for the NASH epidemic: a call to action","volume":"161","author":"Kanwal","year":"2021","journal-title":"Gastroenterology"},{"key":"2025073113175734000_11.6.e003763.24","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvab155","article-title":"Underrecognition of nonalcoholic fatty liver disease in poorly controlled diabetes: a call to action in diabetes care","volume":"5","author":"Alexopoulos","year":"2021","journal-title":"J Endocr Soc"}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2023-003763","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T20:18:03Z","timestamp":1753993083000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2023-003763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":24,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,11,29]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bmjdrc-2023-003763"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2023-003763","relation":{},"ISSN":["2052-4897"],"issn-type":[{"type":"electronic","value":"2052-4897"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}