Study on NAFLD in Type 1 Diabetes Patients

A recent study found that in adults with type 1 diabetes (T1DM) with obesity and metabolic syndrome, liver scores indicating steatosis are common and are linked with dyslipidemia, hypertension, and older age. The findings, published in the Journal of Diabetes and its Complications, imply the importance of adding liver disease screening into routine diabetes care.

The researchers showed a positive hepatic steatosis index score in all participants with T1D and obesity and 64.9% among overweight, while only 22.3% among those with normal weight. NAFLD is under-investigated in patients with T1DM, as most individuals have normal liver transaminase levels.

"By screening our adult type 1 diabetes clinic population with validated liver scores, we found that NAFLD steatosis measures are highly prevalent in over half of patients," the authors wrote.

Michelle D. Lundholm, Cleveland Clinic, Cleveland, United States of America, and colleagues conducted the study to investigate the prevalence and clinical risk factors for NAFLD (non-alcoholic fatty liver disease) in type 1 diabetes by liver scores in a retrospective, unicenter, cross-sectional analysis.

The study included adults with type 1 diabetes from 2015 to 2018. Four hundred forty-seven patients, 38 ± 14.5 yrs, 54% female, BMI 28 ± 5.9 kg/m² were included. Steatosis scores (Framingham steatosis index-FSI, hepatic steatosis index-HSI) and fibrosis scores (AST-to-platelet ratio index-APRI, FIB-4 index) were associated with clinical parameters.

Study Findings

• Liver steatosis was prevalent at 61% by HSI ≥ 36 and 52% by FSI ≥ 23.
• A majority of these individuals had normal liver transaminase levels.
• The presence of advanced fibrosis was 4% by APRI > 0.7 and 4% by FIB-4 > 2.67.
• BMI ≥ 25 kg/m² correlated with steatosis scores but not fibrosis scores.
• Older age (≥40 yrs), hypertension, dyslipidemia, and history of cardiovascular disease were associated with steatosis markers.
• Only 21% had any abdominal imaging, 2% had a hepatology referral, and 1% had a liver biopsy.
• Glucagon-like peptide-1 agonist was prescribed in 5% and thiazolidinedione in 4%.

As seen in an endocrinology clinic, NAFLD steatosis but not fibrosis by liver scores was prevalent among type 1 diabetes patients. Patients with BMI ≥25 kg/m² and age ≥40 years were more likely to have positive liver scores and should be screened for non-alcoholic fatty liver disease. Overall, NAFLD is under-investigated in this population, as a minority of patients with T1DM have had any liver imaging or hepatology evaluation.

Reference

Lundholm, M. D., Bena, J., Zhou, K., Tsushima, Y., & Kashyap, S. R. (2023). Prevalence and clinical determinants of non-alcoholic fatty liver disease by liver scores in adults with type 1 diabetes. Journal of Diabetes and its Complications, 37(2), 108405. https://doi.org/10.1016/j.jdiacomp.2023.108405