Effects of Empagliflozin on Liver Fat Content, Energy Metabolism and Body Composition in Patients With Type 2 Diabetes

Inclusion Criteria: * age between 18 and 75 years * BMI\<45 kg/m2 * known diabetes duration up to 7 years * 6%≤HbA1c≤8% * drug naïve - no previous antihyperglycemic treatment or one month washout period of treatment with oral glucose lowering drugs (no previous treatment with thiazolidinedione (TZD) drugs allowed) * obtained written informed consent Exclusion Criteria: * uncontrolled hyperglycaemia at screening (glucose level ≥240 mg/dl after an overnight fast, confirmed by a second measurement) * acute coronary syndrome, stroke or transient ischemic attack within 3 months prior to consent * previous lower limb amputation * severe lower limb infection/ulceration within 3 months prior to consent * liver disease including chronic viral hepatitis (B or C), alcohol abuse, hemochromatosis, alpha-1 antitrypsin deficiency, autoimmune hepatitis, Wilson's disease, primary sclerosing cholangitis or primary biliary cirrhosis, or liver cirrhosis of any etiology * AST or ALT \> 3 x ULN * positive result on hepatitis B (HBs-AG), hepatitis C (HCV-AB), or HIV 1 and 2 test * impaired kidney function (estimated glomerular filtration rate \[eGFR\]\<60 mL/min/1.73m2) during screening * structural and functional urogenital abnormalities, that predispose for urogenital infections * gastrointestinal surgeries that induce chronic malabsorption * history of cancer (except basal cell carcinoma) or treatment for cancer within 5 years * blood dyscrasias or any disorders causing haemolysis or unstable erythrocytes * treatment with antiobesity drugs 3 months prior to consent * treatment with immunomodulatory drugs (oral steroids, antihistamines) * change in dosage of thyroid hormones within 6 weeks of consent * pregnancy, lactation period * metal or magnetic implants, devices or objects inside of or on the body, which are not MRI compatible (according to MRT safety checklist in Appendix 11.3) * claustrophobia * cigarette smoking (non-smoker \< 1year), alcohol consumption (male \>30 g/d, female \>20g/d) * drug abuse or psychiatric disease * night-worker or circumstances not allowing normal day-night rhythm * hypersensitivity to empagliflozin (or drugs of similar chemical structure) or any of the drug compounds * pharmaceutical preparations with which interactions can be expected - amiloride, furosemide, indapamide, spironolactone, torasemide, triamterene * use of anti-NASH drugs (vitamin E, ursodeoxycholic acid, S-adenosylmethionine, betaine, silymarin, gemfibrozil, anti-TNF therapies, probiotics) in the 3 months prior to randomization * women of childbearing potential not using two adequate methods of contraception including a barrier method and a highly efficacious non-barrier method * persons with any kind of dependency on the investigator or employed by the sponsor or investigator * persons held in an institution by legal or official order * participation in another trial in the last 10 weeks before randomization or planned participation during the trial period