1576-P: Evaluation of Hepatic Steatosis and Adiposity in People with Type 1 Diabetes and Obesity

Introduction: Prevalence of obesity in T1D is rising, contributing to the development of hepatic steatosis (HS) with the associated risk for metabolic dysfunction associated steatotic liver disease (MASLD). While T2 D and MASLD are reliably linked, prevalence of MASLD in T1D varies by the imaging modality employed. We therefore estimated the prevalence of HS and examined the key determinants of HS in people with T1D with BMI≥ 30 kg/m2.

Methods: In a cross-sectional study, 42 individuals with T1D on a continuous glucose monitor (CGM) with duration of diabetes >10 years and BMI ≥ 30 kg/m2 were studied. MRI-Proton Density Fat Fraction (PDFF) was used to estimate HS. Visceral (VAT) and subcutaneous adiposity (SAT) measures were obtained. Linear regression models were used to evaluate the association between HS, VAT, and SAT, with outcomes of glycemic control and insulin resistance.

Results: Participants had a mean (SD) age of 47.8 (13.3) y, 59.5% were men with BMI -32.9 (3.1) kg/m2 and 30.6% had a family history of T2D. Mean A1c was 7.1 (0.77), TIR of 65% (12.5), and TAR of 32.8(12.2) and GMI of 7.2(0.45). Prevalence of HS was 9.5% in the study sample. No statistically significant associations were found between any of the parameters evaluated and HS although a trend was observed for total daily dose of insulin in units (TDDI) (p=0.06) with higher insulin doses positively associated HS. Higher A1c (p =0.004), lower TIR (p=0.02), higher TAR (p =0.009) and higher TDDI (p<0.0001) were associated with higher VAT in the unadjusted models and remained significant for TDDI and VAT (p=0.01) when adjusted for age, sex, and WC.

Conclusion: Our study, which incorporates CGM metrics in a distinctive subpopulation of T1D with obesity, suggests a lower prevalence rate of HS when a sensitive imaging modality such as MRI-PDFF was used. Lack of portal hyperinsulinemia may contribute to lower HS in T1D. The results suggest that markers of insulin resistance and glycemic exposure correlate with VAT but not HS in adults with T1D and obesity.