Steatotic liver disease in diabetic patients: more serious diabetes mellitus, more serious liver disease


İstemihan Z., Bektaş F., Bardak A. E., Kızıltaş C., Kemeç G., Nurıyev K., ...More

EASL Congress 2024, Milan, Italy, 5 - 08 June 2024, pp.551

  • Publication Type: Conference Paper / Summary Text
  • Doi Number: 10.1016/s0168-8278(24)01638-6
  • City: Milan
  • Country: Italy
  • Page Numbers: pp.551
  • Istanbul University Affiliated: Yes

Abstract

Background and Aims: It was aimed to investigate the frequency of metabolic dysfunction-associated

steatotic liver disease (MASLD) in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes

mellitus (T2DM) and to reveal the relationship between complications of diabetes and steatotic liver and

fibrosis.

Method: In a single-center study conducted at a tertiary university hospital, MASLD was prospectively

evaluated with noninvasive scoring based on biochemical tests and FibroScan® in adult patients with

T1DM and T2DM and without other causes of liver disease. In FibroScan® measurements, a CAP score

of ≥ 275 dB/m was considered as steatosis and ≥ 8.0 kPa was considered as clinically significant fibrosis

(F2). Demographic information, waist circumference, weight and height, biochemistry, noninvasive

scoring, and FibroScan® measurements of the patients were recorded.

Results: 504 (83%) of a total of 605 diabetic patients had T2DM. 267 (44%) of the patients were male,

the mean age was 56.22 ± 14.68 years, and the mean body mass index was 29.02 ± 6.02 kg/m2. The

frequency of steatotic liver and clinically significant fibrosis was higher in T2DM patients than in T1DM

patients (p < 0.05). Clinically significant fibrosis was more common in patients with hypertension (HT)

and microalbuminuria (p = 0.01). As the severity of liver steatosis increased, the rate of clinically

significant fibrosis increased (p = 0.01). The grade of liver steatosis was higher in diabetic patients with

microvascular complications (p < 0.05). Considering the lipid profiles, the degree of significant fibrosis

and steatosis was higher in patients with low HDL levels (p = 0.003, p = 0.001, respectively).

30% (n = 153) of T2DM had clinically significant fibrosis, and only 23.5% of them (n = 36) had ALT > 45

U/L. 5% (n = 5) of T1DM had clinically significant fibrosis, and only 1 patient had ALT > 45 U/L. FIB-4

score was ≥ 1.3 in 60 (23.8%) of 252 patients with T2DM and SLD, and the rest had FIB-4 < 1.3. Liver

stiffness was found ≥ 8 kPa in 32.8% of those with FIB-4 score < 1.3.

In all patients, 'FIB-4' had the strongest correlation with liver stiffness measurement, and 'fatty liver index'

had the strongest correlation with CAP score.

Conclusion: Steatotic liver and fibrotic liver are more common in patients with T2DM than in T1DM. As

the severity of liver steatosis increases, fibrosis progresses. Concomitant hypertension,

microalbuminuria, microvascular complications, and dyslipidemia in diabetic patients are associated

with significant fibrosis and increased steatosis in the liver. The noninvasive tests that correlate best

with FibroScan® measurements are FIB-4 and 'fatty liver index'. According to the results of our study,

40% of patients with T2DM and SLD need to be referred to gastroenterologists because they have

clinically significant fibrosis.