In patients with type 2 diabetes (T2D) , studies on nonalcoholic steatohepatitis (NASH) and hepatic fibrosis have been hindered by the constraints of histopathological diagnosis. We assessed the prevalence of, and features associated with, histologically proven NASH and fibrosis in a large group of T2D patients routinely screened for nonalcoholic fatty liver disease (NAFLD) .T2D outpatients with suspected NAFLD at their annual workup (based on ultrasound and liver function test results) were prospectively referred to an hepatologist. Patients with persistently elevated ALT (> 20 IU/L in females or > 30 IU/L in males) and no other causes for liver disease were proposed liver biopsy. Histological lesions were blindly analyzed by a single expert pathologist. Between October 2018 and March 2021, among 1,159 T2D patients screened, NASH and advanced fibrosis were found in 58% and 38% of 330 patients with adequate liver biopsy, respectively. Sequential use of FIB-4 and liver stiffness to rule in/out advanced fibrosis according to EASL algorithm, resulted in a 27% rate of false negative results in patients with FIB-4 <;1.3, and in 32% rate of false positive results in patients with FIB-4 >1.3 and liver stiffness >8 kPa. Hypertension, waist circumference, triglycerides, aspartate aminotransferase, serum albumin and creatinine, were independently associated with NASH (AUROC 0.81 (95% CI 0.76-0.86)) . Waist circumference, gamma-glutamyl transpeptidase, FIB-4 and HDL cholesterol were independently associated with advanced fibrosis (AUROC 0.77 (0.72-0.83)) . Vascular complications of T2D were not associated with liver lesions.

In conclusion, more than half of T2D patients with NAFLD displayed severe hepatic injuries. Liver lesions were independently associated with metabolic syndrome, but not with complications of T2D. Screening for NASH and advanced fibrosis should be part of regular workup of T2D patients. Models based on easily available variables may be useful.


J.Gautier: Other Relationship; Novo Nordisk, Sanofi, Speaker's Bureau; Eli Lilly and Company. H.Bihan: Other Relationship; Vitalair. J.Julla: Consultant; Sanofi. E.Larger: None. S.Pol: Board Member; AbbVie Inc., Gilead Sciences, Inc., Novo Nordisk. P.Bedossa: None. C.Laouenan: None. D.C.Valla: Advisory Panel; Intercept Pharmaceuticals, Inc. L.Castera: Advisory Panel; Alexion Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc., Speaker's Bureau; Novo Nordisk. T.Vidal-trecan: None. V.Paradis: Consultant; Inventiva Pharma, Servier Laboratories. T.Poynard: Stock/Shareholder; Biopredictive. S.Czernichow: Consultant; Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Lilly, Novo Nordisk. B.Terris: None. P.Manchon: None. D.Roulot: Consultant; AbbVie Inc., Gilead Sciences, Inc.


Agence Nationale pour la Recherche (ANR-17-T171105J)

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