The prevalence and markers of liver complications in the T2D population with poor glycemic control remains uncertain.

Using participant data from the National Health and Nutrition Examination Survey (NHANES), we examined the association of poor glycemic control with NAFLD using controlled attenuation parameter (CAP) obtained via FibroScan. We next examined 121 markers indicative of liver dysfunction associated with poor glycemic control (A1C > 7%). We tested the association of each marker with A1C > 7%, and used false discovery rate criteria to identify liver markers that are strongly associated with poor glycemic control. We determined the dose-response between clinical biomarkers as a function of different severity levels of poor glycemic control.

The survey-adjusted prevalence of self-reported liver disease in the diabetic population is 7.4% (95% CI: 6.4, 8.4) and it is 3.2% (95% CI: 2.8, 3.4) in the nondiabetes group. The prevalence of NAFLD in the diabetes population, in contrast, is 69.4%, 95% CI: [62.6%, 76.1%] with prevalence in the group with glycemic control at 60.3% (95% CI: 50.7, 70) and those with poor glycemic control at 82.7% (95% CI: 76.2, 89.3). In multivariate models (adjusted for sex, age, ethnicity, body mass index, the use of 0, 1, 2 or more antihyperglycemic medications and smoking), poor glycemic control (A1C above 7%) was associated with increased odds of NAFLD (OR = 3.28, 95% CI: 1.72 - 6.27, p = 0.02). We identified poor glycemic control (A1C above 7%) was associated with 13 markers of liver disease and identified a linear increase in dose-response for these markers with increased severity of poor glycemic control.

Poor glycemic control is associated with high prevalence of NAFLD in the United States. Liver dysfunction with poor glycemic control is comparable to cardiovascular and kidney dysfunction, highlighting the need for greater vigilance of liver disease in T2D patients especially in those with poor glycemic control.


K. Claypool: None. C. Patel: Consultant; Self; Doc. ai, Janssen Research & Development, LLC, Stock/Shareholder; Self; Xy Health, Inc.


National Institute of Allergy and Infectious Diseases (R01AI127250)

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