Endocrine Abstracts

Aim: Non-alcoholic fatty liver disease (NAFLD) and type 2 Diabetes (T2D) are common conditions that frequently co-exist. Studies have shown an increase likelihood of micro and macrovascular complications in this population, as well, as an increased risk of developing more severe forms of liver disease. The aim of this study was to identify diabetic complications in patients with both diseases and search for an association with liver stiffness assessed by Liver Elastography (LE).

Methods: We retrospectively reviewed patients with T2D and NAFLD (May 2016-December 2017) after excluding other causes of liver disease and in whom LE was performed (LE ≥8.2 kPa reflects fibrosis, LE ≥9.9 kPa reflects significant fibrosis).

Results: We reviewed 555 patients, 25% (139) had NAFLD. 33.8% (47) of the patients with NAFLD had T2D, and up to 73.4% (102) had T2D or Prediabetes. In the T2D population, 68.1% (32) were men between 39-81 years old (60.1±8.7) with 6.02±4.99 years of evolution. 85.1% had metabolic syndrome: 97% BMI ≥25 kg/m², 76.6% dyslipidemia, 70.2% high blood pressure, 21.3% OSAS and 17% hyperuricemia. 80.8% had ALT> AST, and 48.9% ALT ≥40 IU/L. Liver fibrosis assessed by LE was present in 29.8% of the patients, 20% had significant fibrosis. A positive correlation was found between kPa and glomerular filtration rate (CKD-EPI) (r=0.331, P≤0.05), and liver stiffness increased as glomerular function worsened (P=0.008). However, we did not find an increased prevalence of diabetic retinopathy nor diabetic neuropathy in patients with fibrosis. Patients with fibrosis had a higher non-significant prevalence of peripheral artery disease, carotid obstruction and cardiovascular events in comparison with the group without fibrosis (P=0.595, P=0.154, P=0.241, respectively). No increased prevalence of cerebrovascular events was found in patients with liver fibrosis.

Conclusions: Liver fibrosis is highly prevalent in patients with NAFLD and T2D. Increased liver stiffness is significantly associated with renal dysfunction in T2D and a higher non-significant prevalence of cardiovascular events was found in this population. Thereby, our results support the value of LE and the assessment of individual cardiovascular risk in every patient with T2D and NAFLD.