Endocrine Abstracts

Background and Aims: The metabolic-associated fatty liver disease (MAFLD) is a fatty liver accumulation with metabolic dysfunction (diabetes, overweight/obese, insulin-resistance), a definition more practical for identifying patients with fatty liver disease with high risk of disease progression. The triglyceride-glucose (TyG) index is a marker of insulin resistance. Long-term fasting plasma glucose (FPG) variability is associated with fatty liver content (FLC). Continuous glucose monitoring (CGM)-derived time in range (TIR) is a valuable blood glucose metric and the concept of TIR has emerged from the efforts of diabetes experts to discover a reliable parameter, “beyond HbA1c” to assess glycemic control. Hence, an effective treatment should always target to increase TIR vs Time-below-range (TBR).

Methods: 18 Type 2 diabetic patients (M/F:9/9; aged 56 ± 8yr; BMI: 28.3 ± 2.4; duration: 10.2 ± 4,5 yr; FPG: 8.5 ± 1.5 mmol/l; HbA1c:7.9 ± 0.6%) treated with DPPIV/metformin with proven MAFLD were recruited. Antidiabetic therapy was shifted to dulaglutide/pioglidazone. The TyG index was calculated as ln [fasting triglyceride level (mg/dl)×fasting plasma glucose level (mg/dl)/2] and TIR/TBR by real-time (GlucoMen® Day CGM). The primary endpoint was percentage of TIR and TyG index score after 90 days.

Results: A mean TIR (73.1% dulaglutide/pioglidazone vs 68.8% DPPIV/metformin, respectively) or estimated treatment difference (2.96% or 60.9 min/d) and reduced nocturnal TBR (<3.9mmol/l) were observed. TyG index was positively correlated with HbA1c and negatively with TIR and is a useful tool for assessing glycemic control in T2D patients.

Conclusions: These evidences supported % TIR as an important outcome variable of glycemic control in treatment practice. Compared with HbA1c, CGM-TIR may better capture risk of MAFLD worsening and lower TIR was associated with MAFLD evolution. The TyG index was correlated with the severity of hepatic steatosis (FLC). Dulaglutide/pioglidazone compared with DPPIV/metformin, provided more TIR and time in tight glycaemic range, and reduced TyG in type 2 diabetes.