In support of a multiple-hit pathophysiology, studies have now indicated that early antidiabetic drug failure is related to increased hepatic transaminase levels within the normal range.11 Such small increases in aspartate aminotransferase (AST) and alanine transaminase (ALT) may be early indicators of the NAFLD pathway activation toward the development of T2D and reflective of a multitude of simultaneous, macro- and micro-metabolic alterations occurring within the patient. Here, GPT is linked to type 2 diabetes mellitus.