Nonalcoholic fatty liver disease (NAFLD) and its severe form, nonalcoholic steatohepatitis (NASH), can lead to cirrhosis, hepatocellular carcinoma, cardiovascular disease, and type 2 diabetes. Type 2 diabetes is a significant risk factor for NASH, especially when associated with obesity. While lifestyle changes are crucial, early pharmacological interventions for obesity and type 2 diabetes are essential to treat NASH and prevent disease progression. This article reviews current guidelines on the use of pharmacological agents such as pioglitazone, glucagon-like peptide 1 (GLP-1) receptor agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in NAFLD and NASH. It also discusses new drugs under investigation for NASH treatment. Pioglitazone, a thiazolidinedione derivative, has been shown to improve NASH in patients with type 2 diabetes, reducing fibrosis and improving liver function. GLP-1 receptor agonists, such as liraglutide and semaglutide, have demonstrated benefits in reducing hepatic triglycerides and improving glycemic control, weight loss, and cardiovascular outcomes. SGLT2 inhibitors, including dapagliflozin, empagliflozin, and canagliflozin, have been found to reduce hepatic steatosis and improve glycemic control, but their effects on NASH resolution are less clear. The article also highlights the importance of early intervention and management of obesity and type 2 diabetes to prevent cirrhosis, progression from prediabetes to type 2 diabetes, and cardiovascular disease. Novel drugs, such as lanifibranor, resmetirom, and fibroblast growth factor 21 analogs, are being developed for NASH treatment, with ongoing clinical trials evaluating their efficacy and safety. In conclusion, effective treatments like pioglitazone and GLP-1 receptor agonists can significantly improve NASH in patients with type 2 diabetes, and early intervention is crucial to prevent disease progression and associated complications.Nonalcoholic fatty liver disease (NAFLD) and its severe form, nonalcoholic steatohepatitis (NASH), can lead to cirrhosis, hepatocellular carcinoma, cardiovascular disease, and type 2 diabetes. Type 2 diabetes is a significant risk factor for NASH, especially when associated with obesity. While lifestyle changes are crucial, early pharmacological interventions for obesity and type 2 diabetes are essential to treat NASH and prevent disease progression. This article reviews current guidelines on the use of pharmacological agents such as pioglitazone, glucagon-like peptide 1 (GLP-1) receptor agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in NAFLD and NASH. It also discusses new drugs under investigation for NASH treatment. Pioglitazone, a thiazolidinedione derivative, has been shown to improve NASH in patients with type 2 diabetes, reducing fibrosis and improving liver function. GLP-1 receptor agonists, such as liraglutide and semaglutide, have demonstrated benefits in reducing hepatic triglycerides and improving glycemic control, weight loss, and cardiovascular outcomes. SGLT2 inhibitors, including dapagliflozin, empagliflozin, and canagliflozin, have been found to reduce hepatic steatosis and improve glycemic control, but their effects on NASH resolution are less clear. The article also highlights the importance of early intervention and management of obesity and type 2 diabetes to prevent cirrhosis, progression from prediabetes to type 2 diabetes, and cardiovascular disease. Novel drugs, such as lanifibranor, resmetirom, and fibroblast growth factor 21 analogs, are being developed for NASH treatment, with ongoing clinical trials evaluating their efficacy and safety. In conclusion, effective treatments like pioglitazone and GLP-1 receptor agonists can significantly improve NASH in patients with type 2 diabetes, and early intervention is crucial to prevent disease progression and associated complications.