INS and metabolic dysfunction-associated steatohepatitis: By contrast, pioglitazone, a thiazolinedione which acts as a selective agonist of peroxisome proliferator-activated receptor (PPAR)-γ improving systemic and hepatic insulin sensitivity, is the drug with the highest level of evidence for the treatment of NASH in patients with prediabetes/T2DM, as it improved steatosis and inflammation and may reduce hepatic fibrosis.130,131