INS and metabolic dysfunction-associated steatohepatitis: Pharmacologic options include pioglitazone and metformin, both of which are insulin-sensitizing agents6 that are used to treat T2DM.7, 8 Studies of these drugs have reported their effectiveness in the treatment of NASH and its comorbidities.7, 8 However, pioglitazone may promote weight gain, is not available in some countries, and should not be used in patients with heart failure.