Purpose: Fatty liver and Type 2 Diabetes (T2D) are components of insulin resistance, but the prevalence of fatty liver disease at diagnosis of youth onset T2D is unknown. Fatty liver disease is typically identified initially by elevated alanine aminotransferase (ALT). We aim to describe the prevalence of ALT elevation in youth onset T2D at diagnosis and associated risk factors.

Methods: We conducted a single center retrospective review of patients (age≤21) diagnosed with T2D (5/1/2015-12/31/21). Chi-squared and two sample t-tests were used to compare those with ALT values in the highest and lowest quartiles at diagnosis for categorical and linear variables.

Results: Analysis included 455 patients. ALT was elevated at diagnosis and varied widely (mean=70.4 IU/L, standard deviation=76.0 IU/L). At diagnosis 48% of patients had ALT ≥45 IU/L and 14% had ALT ≥135 IU/L. Compared to those with ALT values in the lowest quartile, those in the highest quartile were more likely to be male (p=0.0001), Hispanic (p<0.00001), have a lower HgbA1C (8.9% vs 9.8%, p=0.001), and not identify as Black (p<0.00001). There was no difference in BMI Z-score. A follow-up ALT (6-18 months later) was available in 49% of patients: 37% had ALT≥45 IU/L and 7% had ALT≥135 IU/L (Figure 1).

Conclusions: Elevation of ALT is common at diagnosis of youth onset T2D, but often improves. Those with elevated ALT tend to have a lower HgbA1C and a similar BMI.


S.E.Delacey: None. S.Feng: None. A.Ranganna: None. M.Fishbein: None. M.E.Bianco: None.


National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007169)

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