Effect of Oral Anti-diabetic Medication on Liver Fat in Subjects With Type II Diabetes and Non-alcoholic Fatty Liver

Inclusion Criteria: * Patient who give informed consent voluntarily * Type 2 diabetic patient having age from 18 years to 60 years * HbA1C ≥ 7.0 % * Diabetes diagnosis of ≤ 5 years (longer duration more likely to be associated with use of multiple drug regimens for glycemic control which may affect liver fat mass) * Either treatment naïve or on metformin alone or metformin/DPP4i combination * Absolute weight \< 100kg; BMI \< 45 (fibro scan machine cannot accommodate heavier individuals) * Documented hepatosteatosis (If the fibroscan reveals S1 (mild fatty liver: 11-33% fatty liver) to S3 (severe fatty liver: \> 67% fatty liver) liver fat Exclusion Criteria: * Hba1c ≥ 9% and/or blood sugar \> 250mg/dl * History of uncontrolled Endocrine disorder (for example uncontrolled hypothyroidism, or that requiring frequent dose adjustment, or Cushings syndrome) * History of anti-obesity medication use within 3 months of consent for study enrollment or weight loss procedure(bariatric surgery) within same duration * History of use of SGLT 2 inhibitors, glitazones, Glucagon-like peptide (GLP) 1 agonists 3 months prior to study enrollment as they influence liver fat * History of use of insulin/sulphonylurea 3 months prior to study enrollment owing to weight gain and potential increase in liver fat conferred by these agents * History of vitamin E use (400mg twice daily) within 3 months of study enrollment * Drug induced liver disease or active substance abuse (cannabonnoid-derived substances like heroin, cocaine, amphetamines) based on history and/or laboratory tests * Drugs known to be associated with hepatic steatosis like steroids, traditional homeopathic medication (likely to contain steroids), methotrexate, valproate, tamoxifen, amiodarone. * Alcohol use (History of alcoholism or a greater than recommended alcohol intake (\> 21 standard drinks on average per week in men and \> 14 standard drinks on average per week in women) * Severe hepatic impairment (ALT levels \> 3 times upper limit normal) * Hepatitis B/C hepatitis (based on positive Hepatitis B surface antigen, Anti Hepatitis C antibodies positive * Autoimmune hepatitis (in case of females), based on positive Anti-nuclear Antibody (ANA) (homogenous, high titre) * Positive Human Immunodeficiency Virus ( HIV) test as this could influence liver functions * Pregnant or lactating women/ plans for pregnancy over proceeding 13 months * Obstructive liver disease on the basis of laboratory and imaging studies * Chronic renal failure, or Glomerular Filtration Rate (GFR) \< 30 mls/minute (as estimated by the MDRD equation) * Chronic heart failure, history of acute coronary artery disease or cerebrovascular accident within 3 months of consent for study enrollment, based on history and/or cardiac imaging * History of recurrent Urinary Tract Infections (UTI's) or mycotic infections * Presence of ketones on Urine Analysis