T2DM increases risk for advanced fibrosis in NAFLD, however little is known about the impact of glycemic control on fibrosis severity.
Objective: To assess whether glycemic control is associated with severity of fibrosis in NAFLD.
Methods: We utilized the Duke NAFLD Clinical Database to examine the association between HbA1c and fibrosis in patients with biopsy (Bx)-proven NAFLD (n=941). A generalized linear regression model was used (adjusted for age, gender, race, BMI, HLD, eGFR) to assess the association of mean HbA1c (1 year pre- to 90d post-Bx) and fibrosis severity (stage 3-4=advanced vs. 0-2=mild). Patients with ≥3 HbA1c values (n=335) were examined by group-based trajectory analysis using HbA1c over 5 yrs pre- to 90d post-Bx.
Results: Every 1% increase in mean HbA1c was associated with 20% higher odds of advanced fibrosis (OR 1.20, 95%CI 1.02, 1.39 p=0.02). Group-based trajectory analysis identified three glycemic patterns - good, moderate and poor (groups 1,2,3, respectively); proportion of advanced fibrosis increased with worse glycemic control. Group 2 had higher odds of advanced fibrosis than group 1 (OR 4.46, 95%CI 2.29,8.70, p<0.01). Group 3 estimates were limited by small sample size (OR vs. group 1: 2.55, 95% CI 0.87,7.44, p<0.01).
Conclusion: Glycemic control preceding Bx impacts severity of liver fibrosis. We are currently analyzing 65 patients with paired Bx to assess impact of HbA1c trends on change in fibrosis severity.
A. Alexopoulos: None. M. Crowley: None. Y. Wang: None. C.D. Guy: Consultant; Self; CymaBay, HistoIndex, Madrigal, NGM. R. Henao: None. K.A. Seymour: Other Relationship; Self; Gore, Medtronic. R. Sudan: None. D. Portenier: Consultant; Self; Medtronic. Speaker’s Bureau; Self; Novo Nordisk Inc. A. Diehl: None. M.F. Abdelmalek: None. A.D. Coviello: Consultant; Self; GI Dynamics Inc., Novo Nordisk Inc. Research Support; Self; Allergan plc., GENFIT, Orthus Health. Speaker’s Bureau; Self; Novo Nordisk Inc.
Endocrine Fellows Foundation