NAFLD is common in diabetes, however the prevalence and clinical features of NAFLD in T1DM are not well defined.

A retrospective, unicenter, cross-sectional analysis was performed of adults with T1DM at our institution from 2015-2018. The hepatic steatosis index (HSI) , Framingham steatosis index (FSI) , FIB-4 index, and AST-to-platelet ratio index (APRI) were calculated and associated with clinical parameters.

We identified 447 patients, 38.6 ± 14.5 yrs, 54% (N=241) female, HgA1c 8.4 ± 1.8 %, BMI 28 ± 5.9 kg/m2. The prevalence of NAFLD by HSI ≥36 was 61% (N=271) and by FSI ≥23 was 52% (N=230) . The presence of advanced fibrosis by APRI >0.7 was 4% (N=18) and FIB-4 >2.67 was 4% (N=8 of 221 included) . Patients with metabolic syndrome (N=103, 23%) were significantly more likely to have NAFLD by HSI (86% vs. 53%, p<0.001) and FSI (93% vs. 39%, p<0.001) . Compared to BMI <30, nearly all patients with BMI ≥30 (N=125, 28%) had NAFLD by HSI (100% vs. 45%, p<0.001) and FSI (98% vs. 34%, p<0.001) . Older age (44 vs. 33 yrs) , HTN, HLD, cardiovascular disease, and higher TG/HDL ratio (median 1.8 vs. 1.1) were associated with FSI ≥23. Older age (41 vs. 30 years) , HTN, HLD, and lower HDL (58 vs. 66 mg/dL) were associated with HSI ≥36. On multivariable analysis, older age, metabolic syndrome features, and BMI were associated with higher HSI and FSI. HgA1c was inversely related to HSI. Twenty of 94 patients (21%) with abdominal imaging reported hepatic steatosis; 8 (2%) had hepatology referral and 6 (1%) had a liver biopsy. Of 447 patients, GLP-1 agonist was prescribed in 5% (N=24) and thiazolidinedione in 4% (N=16) .

Liver scores indicating liver steatosis but not fibrosis is common in adults with T1DM with obesity and/or metabolic syndrome, and is associated with older age, HTN, HLD, and high TG/HDL. NAFLD is overlooked; only 21% of patients had any liver imaging and only 1% had a liver biopsy. Thiazolidinedione and GLP-1 agents are effective at preventing and reversing NAFLD damage but appear underutilized in the T1DM population.


M.D.Lundholm: None. J.F.Bena: None. K.Zhou: None. Y.Tsushima: None. S.Kashyap: Advisory Panel; Fractyl Health, Inc., GI Dynamics, Research Support; Janssen Pharmaceuticals, Inc.

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