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While pharmaceutical GLP-1 agonists work through direct receptor stimulation, dihydroberberine appears to work through multiple complementary pathways, supporting not only GLP-1 production but also enhancing insulin sensitivity and reducing oxidative stress

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In a phase II RCT including 125 patients with biopsy-proven MASLD and fibrosis F1-F3 and fat infiltration in the liver with at least 10% by MRI-PDFF received placebo or resmetirom 80 mg or 100 mg per day

14 mg: WMD 0.53, P = 0.29 (two studies)