Advanced Fibrosis, Cirrhosis Rates Elevated in Type 2 Diabetes

Approximately 14% of older adult patients with type 2 diabetes mellitus (T2DM) have advanced fibrosis and two-thirds have nonalcoholic fatty liver disease (NAFLD), according to study results published in Journal of Hepatology.

Researchers conducted a prospective, cross-sectional study to assess the prevalence of advanced fibrosis and cirrhosis secondary to NAFLD in patients aged 50 to 80 years with T2DM who were recruited from primary care and endocrinology clinics.

All study participants underwent a standardized clinical evaluation and a noncontrast magnetic resonance imaging (MRI) examination with liver fat quantification and liver stiffness assessment using MRI proton-density-fat-fraction (MRI-PDFF) and magnetic resonance elastography (MRE). The researchers also performed controlled attenuation parameter (CAP) for the detection of liver fat and vibration-controlled transient elastography (VCTE) for the quantification of liver stiffness.

The primary outcome was advanced fibrosis (MRE ≥3.63 kPa, or if not available VCTE ≥8.8 kPa). The researchers defined NAFLD as MRI-PDFF of at least 5%, or if not available CAP of at least 288 dB/m in participants who consumed little or no alcohol with no secondary cause for hepatic steatosis or other causes of liver diseases. Cirrhosis was defined as MRE of at least 4.67 kPa, or if not available VCTE of 15 kPa or higher.

A total of 501 participants were included, of whom 98% (n=493) had a valid liver stiffness measurement on MRE or VCTE. The cohort had a mean age of 64.4 (±8.1) years, 63% were women, and the mean body mass index (BMI) was 31.4 (±5.9) kg/m².

The prevalence of NAFLD was 65.3% (n=322). Patients with NAFLD were more likely to be younger, female, have an increased BMI or obesity, be of Asian ethnicity, and have metabolic syndrome. Participants in the NAFLD group had a higher mean (SD) CAP and MRI-PDFF vs participants in the non-NAFLD group at 330 (45) dB/m vs 265 (53) dB/m (P <.001) and 13.8% (7) vs 2.5% (1.4) (P <.001), respectively.

The prevalence of advanced fibrosis was 14%. The prevalence was 22.5% when assessing for significant fibrosis (stage 2 or higher) defined as MRE of at least 3.0 kPa, or if not available VCTE of 8.2 kPa or higher.

After stratification by obesity, the prevalence of NAFLD increased from 55.5% in individuals without obesity to 72.6% in those with obesity (P =.002). The prevalence of advanced fibrosis increased from 8.1% in individuals without obesity participants to 18.2% in  those with obesity (P =.002). The prevalence of cirrhosis was 3.4% in individuals without obesity vs 7.5% in participants with obesity (P =.052).

In multivariable adjustment for age and sex, obesity (odds ratio [OR], 2.49; 95% CI, 1.38-4.54; P =.003) and insulin use (OR, 2.71; 95% CI, 1.33-5.50; P =.006) remained associated with advanced fibrosis.

The prevalence of cirrhosis was 5.9% (n=29). In a sensitivity analysis of 404 individuals with MRE and VCTE, 3.5% of the group had MRE of 4.67 kPa or higher and VCTE of 15 kPa or higher.

Among the patients with cirrhosis, 3 had hepatobiliary malignancy within 6 months of the baseline visit, including 2 patients with hepatocellular carcinoma and 1 with gallbladder adenocarcinoma.

Limitations of the study include the cross-sectional study was performed at 1 center, and only a subset of patients underwent liver biopsy.

“These data support the implementation of systematic screening of older adults with T2DM and provide much needed prospective data on the risk of advanced liver disease,” the study authors include.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.