Iron Reduction for the Treatment of Diabetes and Nonalcoholic Fatty Liver Disease

Inclusion Criteria: * Ages 40-75 * At least 3 months since diagnosis of prediabetes or diabetes * HgbA1C value within three months or at screening of 5.7-6.4% for those with prediabetes and 7- 8.5% for those with diabetes (the upper limit of the latter to reduce the likelihood of major changes in glycemic intervention during the trial period, and the lower limit to allow some room for improvement) * Undiagnosed on no medication HgA1C 6.5-6.9 * C-reactive protein levels up to 11.0 * Aim 2-serum ALT\> 1.5 times the upper limit of normal, or; liver stiffness of \> 12.5 kPa by Fibroscan transient elastography * Serum ferritin levels within 1 year or at the time of screening in the upper half of the normal range (\>50 ng/mL for women; \>100ng/mL for men) Exclusion Criteria: * Documented anemia * Hemoglobin levels within 0.5 g/dL of the lower limit of normal (\<12.5 g/dL for women; 13.5 g/dL for men) * Recent blood loss * Bleeding diatheses (coagulation abnormalities or treatment with anticoagulants) * Serious chronic infections or chronic inflammatory conditions that could elevate ferritin as an "acute phase reactant * C-reactive protein greater than the upper limit of normal to further validate the lack of significant chronic inflammation * Active cancer diagnosis (excluding skin cell cancers other than melanoma) * Renal insufficiency (eGFR\<60 ml/min) * History of orthostatic hypotension * Heavy alcohol use (NIH criteria for men, greater than 4 drinks on any day or 14/week) *…