Insulin sensitizers such as pioglitazone have demonstrated histological improvement in NASH, especially in patients with T2DM, but its use is limited by weight gain and concerns about long-term safety [59,60]. Vitamin E, an antioxidant administered at 800 IU/day, has shown benefit in non-diabetic patients with biopsy-proven NASH by reducing hepatocellular injury, but concerns about long-term cancer risk remain [61]. Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) such as liraglutide and semaglutide promote weight loss and reduce hepatic steatosis and inflammation. Here, INS is linked to fatty liver disease.