Patients with nonalcoholic fatty liver disease (NAFLD) and liver biopsies who have type 2 diabetes (T2D) experience a quicker progression of fibrosis compared with those without T2D, according to study results published in Gastroenterology.
Researchers conducted a multicenter study using data from the National Institute of Diabetes and Digestive and Kidney Diseases-sponsored NASH CRN consortium. A total of 447 adults with biopsy-confirmed NAFLD were included in the study. The researchers recorded the presence of T2D at baseline and examined liver histology by grade and stage per NASH-CRN protocol. Pathologists analyzed the liver biopsy specimens.
The primary outcome was the cumulative incidence of a 1-stage or greater increase in fibrosis among the study participants with and without T2D.
Participants had a mean [SD] age of 50.9[11.5] years, mean body mass index (BMI) was 34.7[6.3] kg/m2, 85% were White, 10% were Hispanic, and median time between biopsies was 3.3 (IQR, 1.8-6.1) years.
Participants with vs without T2D at baseline had significantly higher levels of fibrosis progression at least greater than 1 stage at 4 years (24% vs 20%), 8 years (60% vs 50%), and 12 years (93% vs 76%), (P = .005 for all), respectively. Using a multivariable Cox proportional hazards model adjusted for multiple confounders, T2D remained statistically significant and an independent predictor of fibrosis progression (adjusted hazard ratio, 1.69; 95% CI, 1.17-2.43; P = .005). Among participants with vs without T2D, the cumulative incidence of fibrosis regression by 1 stage or greater was similar at 4, 8, and 12 years (P = .24).
Study limitations include sampling variability of liver biopsy, the potential for misclassification of fibrosis stages, and the lack of calculating collagen proportionate area.
“The faster fibrosis progression in people with T2DM should be taken into consideration when designing therapeutic trials and underscores the unmet need for efficacious therapies in this high-risk group,” the study authors noted.
Huang DQ, Wilson LA, Behling C, et al. Fibrosis progression rate in biopsy-proven nonalcoholic fatty liver disease among people with diabetes vs people without diabetes: a multicenter study. Gastroenterology. Published online April 29, 2023. doi:10.1053/j.gastro.2023.04.025