ADA guidelines recommend screening for significant fibrosis in patients with type 2 diabetes and steatosis or elevated ALT. In contrast, there are limited or inconsistent data about the prevalence of NAFLD and liver fibrosis in patients with type 1 diabetes (T1D) . We screened patients with T1D unaware of having NAFLD at a tertiary diabetes center and excluded those with secondary causes of fatty liver or heavy alcohol consumption. We utilized liver stiffness measurement (LSM) by transient elastography for fibrosis screening and controlled attenuation parameter (CAP) for steatosis screening. Referral to hepatology unit was done based on a priori criteria suggestive of clinically significant fibrosis (≥F2) .
We screened 285 patients with T1D (age 48±16 yrs; 55% females; 93% non-Hispanic whites; BMI 27±4.9 kg/m2; diabetes duration 28±15 yrs; A1c 7.1±1.1%; total insulin dose 48±27 units/day; AST 23±9 IU/L; ALT 20±12 IU/L) . The prevalence of NAFLD (CAP≥274 dB/m) was 29.3% (95%CI 24-35) and fibrosis (LSM≥7 kPa) 11% (95%CI 7-15) . Among those with NAFLD (n=76) , 13% (95%CI 5-20) had ≥F2 fibrosis (LSM ≥ 8.2 kPa) suggesting nonalcoholic steatohepatitis. Among patients with NAFLD and those with fibrosis respectively, 72% and 59% had ALT≤30 IU/L (men) or ≤IU/L (women) . After multivariate adjustment, larger waist circumference (>102 cm [men]; >88 cm [women]) and BMI >30 kg/m2 were associated with increased risk of steatosis (OR 4.13, 95%CI 1.61-10.6, p=0.014; 2.4, 1.3-4.5, p=0.007, respectively) . Continuous glucose monitoring parameters (e.g., %TIR) were not associated with steatosis or fibrosis.
In conclusion, NAFLD and liver fibrosis are common in patients with T1D. ALT alone is inadequate for screening. Central obesity, consistent with insulin resistance, independently predicts NAFLD. Future guidelines should consider screening for steatosis and significant fibrosis in patients with T1D and high BMI or large waistline even without elevated ALT.
S.Tomah: None. H.Gardner: None. R.Mccarragher: None. A.A.Kaushik: None. N.A.Ziemniak: None. O.Hamdy: Advisory Panel; L-Nutra Inc., Nestlé, Consultant; Abbott, Sanofi, Research Support; Eli Lilly and Company, Gilead Sciences, Inc., National Dairy Council, Novo Nordisk, Stock/Shareholder; Healthimation. T.Salah: None. M.Al-badri: None. S.E.Dhaver: None. M.P.Curry: Consultant; Gilead Sciences, Inc., Mallinckrodt, Sonic Incytes, Research Support; Gilead Sciences, Inc., Mallinckrodt, Sonic Incytes. Z.Jiang: Advisory Panel; Olix Pharmaceutical, Research Support; Gilead Sciences, Inc., Pfizer Inc. M.Lai: None. O.A.Elenani: None. K.Kibaa: None.
Investigator-initiated grant from Gilead Sciences (IN-US-989-5675)