Endocrine Abstracts

Introduction: The prevalence of metabolic syndrome is increasing in individuals with T1D, which could potentiate the development of NAFLD. The pathophysiology of NAFLD in T1D is still unclear, due to the co-existence of predisposing and protective factors. Insulin resistance (IR) is theorized as a key driver of NAFLD.

Aim: We investigated the association between liver fat content (LFC), NAFLD, and IR in individuals with T1D. Subjects underwent magnetic resonance spectroscopy (MRS) to determine LFC. The estimated glucose disposal rate (eGDR) was calculated in two ways based on: (1) the presence of hypertension, waist circumference (cm), and HbA1c (%), and (2) the presence of hypertension, body mass index (BMI, kg/m²) and HbA1c (%). An eGDR <8 mg/kg/min is considered insulin resistant. A mean LFC ≥ 6.0 % on MRS was considered diagnostic for NAFLD.

Results: Seventy-eight subjects were included. Age was 59 ± 17 years, BMI was 27.6 ± 5.0 kg/m2, waist circumference was 87 ± 13 cm in females and 99 ± 12 cm in males, and hypertension was present in 63%. LFC based on MRS was 4.3 ± 4.0 %, NAFLD was present in 11 (14%) subjects. HbA1c was 7.4 ± 1.2 % indicating good glycaemic control. The eGDRwaist measured 6.4 ± 2.5 mg/kg/min, and eGDR^BMI was 6.4 ± 2.2 mg/kg/min. Correlation between eGDR methods was excellent (r = 0.96, P< 0.001). Kappa between eGDR methods was 0.87, P< 0.001. Prevalence of IR was 27% (eGDR^BMI) and 30 % (eGDR^waist). All 11 cases of NAFLD were in the IR group, regardless of eGDR method. Linear regression showed a weak correlation between eGDR^waist and LFC (r: -0.277, B: -0.442, 95% CI: -(0.792 - 0.091), P=0.014), and between eGDR^BMI and LFC (r: -0.270, B: -0.480, 95% CI: -(0.872 – 0.089, P=0.017). NAFLD was associated with the eGDR^waist as a continuous variable (OR: 0.62, 95% CI: 0.39 - 0.99, P=0.049) in a logistic model including BMI, age, and gender. eGDR^BMI was not significantly associated in a model including waist, age and gender.

Conclusions: These data show that IR, as indexed by the eGDR based on waist circumference, is associated with LFC and the presence of NAFLD in individuals with T1D. More studies are needed to elucidate the role of IR in the etiology of NAFLD in individuals with T1D.