Endocrine Abstracts

Background: Non-alcoholic fatty liver disease and chronic hepatitis C (CHC) are systemic diseases with a broad spectrum of coexisting disorders, but their common features are insulin resistance and higher frequency of concomitant type 2 diabetes mellitus (DM). According to recent studies, a higher frequency of CHC in patients with DM is not associated with this cohort exposure to multiple medical interventions, but with CHC being a possible risk factor for developing DM. CHC may accelerate the development of DM nearly for 10 years compared to the general population.

Aim: To evaluate the part of severe liver disease in CHC patients with type 2 DM taking into account body mass index (BMI).

Materials and methods: Transient fibroelastometry (TF) with the use of «Fibroscan FS-502» and additional Controlled Attenuation Parameter (CAP^TM) function for liver steatosis (LS) quantitative evaluation was performed in 47 patients with CHC and type 2 DM and no history of antiviral treatment. Several groups were formed: with LS (group 1, n=37), without LS (group 2, n=10). Female/male ratio and mean age were 41%/59%, 52±1.7 (39–76 years old), and 40%/60%, 59.1±3.4 (31–71 years old), respectively.

Results: In the study group, LS was diagnosed in 79% (37/47) of cases: no LS – 21% (10/47), LS stage 1 – 4/9%, LS stage 2 – 9/19%, LS stage 3 – 24/51%. Severity of LS in group 1: stage 1 – 4/11%, stage 2 – 9/24%, stage 3 – 24/65%. Obesity of different stages was diagnosed in 73% (27/37) in group 1, 79% out of which with LS stage 2–3. In group 2, obesity was diagnosed in 30% (3/10). Normal BMI was in 6% (3/47) of patients. Mean BMI in group 1 was 34.4±1.0 (in stage 1 LS – 28.8±1.4, stage 2-3 LS – in 35.1±1.1). Mean BMI in group 2 – 27.5±3.2. BMI in LS group varied from 26.2 to 48.3, BMI in the group with no LS – from 20.7 to 38.5. The fibrosis stage patients distribution in group 1 with LS comprised: F0 – 4/11%, F1 – 4/11%, F2 – 7/19%, F3 – 9/24%, F4 – 13/35%. In group 2, severe fibrosis F3 was diagnosed in 70% (7/10).

Conclusion: In the group CHC and type 2 DM, there is a higher percentage of overt LS with concomitant obesity, and severe fibrosis and liver cirrhosis regardless of LS presence. That confirms the priority of the cohort for immediate antiviral treatment irrespectively to diagnosed fibrosis stage on primary examination.