Endocrine Abstracts

Background: A number of reports have associated non-alcoholic steatohepatitis (NASH) with aspects of the metabolic syndrome, such as insulin resistance, dyslipidaemia, type 2 diabetes and obesity. NASH can progress to cirrhosis and hepato-cellular carcinoma, as well as acting as a marker for insulin resistance in patients with type 2 diabetes mellitus.

Aims: The purpose of this study was to determine the prevalence of abnormal liver function in a population of, mainly type 2, diabetic patients, and to assess the feasibility of screening for NASH in this cohort of patients.

Methods: As part of new diabetes assessment, all patients referred to the diabetes clinic in our hospital had liver function measured routinely. We looked mainly at alanine aminotransferase (ALT), alkaline phosphatase (ALP) and bilirubin levels in a total of 959 patients who were tested over a four-year period. We calculated the prevalence of individual abnormal liver function and a combination of 2 or more LFT abnormality in this cohort of patients retrospectively.

Results: 151 patients (15.7%) had raised ALT, 100 patients (10.4%) had raised ALP and 37 patients (3.9%) had a raised bilirubin. The combination of raised bilirubin and ALT was seen in 10 patients (1.0%), bilirubin and ALP was seen in 7 patients (0.7%) and both ALP and ALT were raised in 27 patients (2.8%). Only 3 patients (0.3%) had all three abnormal liver function tests.

Conclusion: A high proportion of patients with diabetes mellitus in our catchment population have abnormal liver function tests that may be a marker for NASH and insulin resistance. Currently, routine liver function screening is not being advocated in type 2 diabetics but emerging evidence suggests that abnormal LFT may be a marker for metabolic syndrome and insulin resistance in type 2 diabetes. Such patients would thus warrant more intensive metabolic control particularly of their hyperglycaemia and dyslipidaemia and also their obesity and hypertension to not only reduce cardiovascular risk attributed to by their insulin resistance but also to prevent progression to significant hepatic dysfunction like cirrhosis and hepato-cellular carcinoma.