The ADA recommends screening for liver fibrosis in all patients with T2DM and with elevated ALT or steatosis. However, the factors that may predispose to hepatic fibrosis, such as comorbid conditions or insulin resistance (IR), have not been carefully examined. To this end, we studied patients with T2DM and NAFLD/fibrosis screened in an outpatient clinical setting. Screening for steatosis was done by controlled attenuation parameter (CAP), fibrosis by liver stiffness (LSM) with vibration-controlled transient elastography (VCTE). Out of 527 patients screened, 350 (66%) had steatosis (age: 60±12 years; BMI: 33±6 kg/m2; A1c: 7.5±1.7%). Based on VCTE, they were divided into LSM ≥ 7.0 kPa (moderate-to-severe fibrosis; n=69) or LSM ≤ 7.0 kPa (no or mild fibrosis; n=281). We measured hepatic (HOMA) and adipose tissue (Adipo-IR: fasting FFA x insulin) IR, FIB-4 and CK-18 (biomarkers of liver fibrosis).
Results are summarized in the Table. Patients with fibrosis had more steatosis, worse HOMA/Adipo-IR and more severe metabolic syndrome. Presence of fibrosis was not evident in most patients by AST/ALT >40 U/L (elevated in just 26%) or FIB-4, but CK-18 was higher.
In conclusion, clinicians should strongly suspect liver fibrosis in patients with T2DM that have the most unfavorable metabolic profile.
S. Kalavalapalli: None. R. Lomonaco: None. E. Godinez: None. N. Fanous: None. L.J. Tejera: None. A. McCauley: None. L. Mansour: None. S. Shrestha: None. J.S. Marte: None. J. Fakhry: None. H. Wang: None. A. Vargas: None. D. Barb: None. F. Bril: None. K. Cusi: Consultant; Self; Allergan plc., AstraZeneca, Bristol-Myers Squibb, Genentech, Inc., Gilead Sciences, Inc., Merck & Co., Inc. Research Support; Self; Cirius Therapeutics, Echosens, Eli Lilly and Company, Inventiva Pharma, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Poxel SA, Zydus Pharmaceuticals, Inc.