The following is a summary of “A prospective study on the prevalence of NAFLD, advanced fibrosis, cirrhosis and hepatocellular carcinoma in people with type 2 diabetes,” published in the March 2023 issue of Hepatology by Ajmera, et al.

Patients with type 2 diabetes mellitus (T2DM) who have been prospectively enrolled and carefully examined for hepatic fibrosis or cirrhosis due to non-alcoholic fatty liver disease are scarce (NAFLD). As a result, they sought to assess the incidence of advanced fibrosis and cirrhosis in a newly-identified group of people with T2DM. Adults with type 2 diabetes, aged 50 or older, were included in this prospective trial through primary care and endocrinology clinics. During a structured clinical research visit, participants underwent MRI proton density fat fraction (MRI-PDFF), MRE, VCTE, and controlled-attenuation parameter imaging. 

After other causes of liver disease were ruled out, NAFLD was defined as an MRI-PDFF of less than 5%. Fibrosis and cirrhosis were classified according to predetermined MRE or VCTE liver stiffness cutoff thresholds. A total of 524 patients were tested for eligibility; 501 people (63% female) with T2DM were found to be appropriate candidates. Those who participated had a mean age of 64.6 (±8.1) and a body mass index of 31.4 (±5.9). NAFLD was seen in 65% of patients, whereas extensive fibrosis was found in 14%, and cirrhosis affected 6%. Obesity and insulin use were also linked with an elevated risk of advanced fibrosis in multivariable adjusted models after controlling for age and sex (odds ratio 2.50; 95% CI 1.38-4.54; P = 0.003 and odds ratio 2.71; 95% CI 1.33-5.50; P = 0.006, respectively). 

Among the 29 cirrhotic patients, 2 were diagnosed with hepatocellular carcinoma and 1 with gallbladder adenocarcinoma. Using a prospective cohort of individuals aged 50 years with T2DM that is both large and well-characterized, they determined that the prevalence of advanced fibrosis was 14% and the prevalence of cirrhosis was 6%. Results like this highlight the serious threat of severe fibrosis/cirrhosis in persons with T2DM who are 50 and older.

Source: sciencedirect.com/science/article/abs/pii/S0168827822033025