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Telmisartan leads to modest fasting blood sugar reduction in patients with MASLDTelmisartan Shows Modest Effects on Blood Sugar in Liver Disease

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Key Takeaway
Note that telmisartan reduces fasting blood sugar in MASLD, but results are limited by high heterogeneity.

This meta-analysis evaluated the effects of telmisartan in 258 adults with MASLD and NAFLD. The primary finding was a modest reduction in fasting blood sugar of -2.78 mg/dL (95% CI -5.17 to -0.39; p = 0.023). However, the authors noted that this specific finding was associated with substantial heterogeneity (I = 91.8%).

Other secondary outcomes, including lipid profiles, BMI, waist circumference, and HOMA-IR, showed no significant changes. While there was a non-significant trend toward improvement in fibrosis stage (effect size -0.28; p = 0.060), it did not reach statistical significance. Additionally, a modest but significant increase in gamma-glutamyl transferase (GGT) was observed (5.40 U/L; p = 0.031).

Several markers of liver pathology, including NAFLD activity score, steatosis, ballooning, and lobular inflammation, showed no significant improvements. The authors noted that the modest effect size and high heterogeneity for the fasting blood sugar reduction necessitate cautious interpretation of the data. Clinical utility is currently limited by these findings and the lack of significant changes in most metabolic and hepatic markers.

How this fits prior evidence

This meta-analysis addresses a gap in the management of MASLD and NAFLD by evaluating the effects of telmisartan. It does not relate to the previously covered finding regarding triple pill therapy for recurrent stroke in patients with prior intracerebral hemorrhage.

Researchers analyzed data from 258 adults with MASLD, a condition involving fat buildup in the liver. The study looked at how the medication telmisartan affected various health markers, including blood sugar levels, body weight, and liver enzymes.

The analysis found that telmisartan led to a modest reduction in fasting blood sugar. However, the researchers noted that this specific finding should be interpreted with caution because the data across different studies was very inconsistent. Other markers, such as body mass index, waist circumference, and various liver health scores, showed no significant changes.

Because this was a meta-analysis of existing data, the results are not definitive for every patient. The small size of the effect on blood sugar and the high inconsistency in the data mean these findings are not yet enough to change standard medical practices. Patients should talk to their doctor about how these findings relate to their specific treatment plan.

What this means for you:
Telmisartan showed a modest reduction in blood sugar, but results were inconsistent and require cautious interpretation.

Common questions

Does telmisartan lower blood sugar in people with liver disease?

The study found a modest reduction in fasting blood sugar of 2.78 mg/dL among adults with MASLD. However, researchers warn that this finding should be interpreted cautiously because the data across the studies were very inconsistent.

Does telmisartan help with weight or liver size?

The study found no significant changes in body mass index or waist circumference. Additionally, there were no significant improvements in liver markers such as steatosis, ballooning, or lobular inflammation.

What other liver markers were affected by telmisartan?

While there was a modest but significant increase in gamma-glutamyl transferase (GGT) by 5.40 U/L, other markers like ALT, AST, and lipid profiles showed no significant changes. There was also only a non-significant trend toward improvement in fibrosis stages.

Study Details

Study typeMeta analysis
Sample sizen = 258
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Activation of the renin-angiotensin-aldosterone system contributes to hepatic inflammation in metabolic dysfunction-associated steatotic liver disease (MASLD). Telmisartan, an angiotensin II receptor blocker with partial PPAR-γ agonistic activity, has been hypothesized to confer metabolic benefits; however, current clinical evidence has not consistently demonstrated such effects. AIM: This systematic review and meta-analysis evaluated the efficacy of telmisartan on metabolic, biochemical, and histological outcomes in MASLD. METHODS: Electronic databases (PubMed, Embase, Web of Science, Scopus) were searched through 2026 for randomized controlled trials (RCTs) investigating telmisartan in adults with MASLD. Risk of bias was assessed using the RoB2 tool. Random-effects meta-analyses calculated pooled mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Six RCTs comprising 258 participants (126 telmisartan, 132 controls) met the inclusion criteria. Telmisartan treatment was associated with a modest reduction in fasting blood sugar compared with controls (MD = -2.78 mg/dL; 95% CI -5.17 to -0.39; p = 0.023); however, this finding was accompanied by substantial heterogeneity (I = 91.8%) and should therefore be interpreted cautiously. No significant changes were observed for body mass index, waist circumference, HOMA-IR, lipid profiles, ALT, or AST. Conversely, gamma-glutamyl transferase (GGT) levels showed a modest but significant increase with telmisartan (MD = 5.40 U/L; 95% CI 0.51 to 10.29; p = 0.031). Histological analyses revealed a non-significant trend toward fibrosis stage improvement (MD = -0.28; 95% CI -0.57 to 0.01; p = 0.060), with no significant improvements seen in the overall NAFLD activity score, steatosis, ballooning, or lobular inflammation. Most included trials carried a low overall risk of bias. CONCLUSION: Current evidence does not demonstrate consistent metabolic, biochemical, or histological benefits of telmisartan in MASLD. Although a modest reduction in fasting blood glucose was observed, substantial between-study heterogeneity and the modest effect size limit confidence in this finding.
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