Aim: In T2D, the prevalence of NAFLD is 56-60% and approximately 40% have DKD; thus, a sizable proportion of subjects may have both conditions. We explored to which extent the coexistence of the two could further worsen mortality and CVD risk in T2D.

Methods: We recorded vital status and data for major CVD (the latter available for 98.5% subjects) were retrieved on December 31st, 2017. DKD (eGFR <60 ml/min/1.73 m2 and/or ACR ≥30 mg/g) and NAFLD (fatty liver index ≥60) effects assessed by Kaplan-Meier curves and hazard ratios (HR, 95% CI) by adjusted Cox regressions.

Results: Distributions of NAFLD and DKD are reported in Table. HbA1c was similar in subgroups; NAFLD had worse metabolic and inflammatory profile, DKD higher hypertension rate. Over a follow-up of 13.1±2.8 years, we recorded 229 deaths (23.8%) and 273 major CV (28.8%). Rates of other outcomes are reported in Table. Death rate was 16.3, 21.8, 25.6 and 43.8% (p<0.0001) across groups with full adjusted HR (Model 2), of 1.50 (1.07-2.10, p=0.020) in NAFLD only, 1.15 (0.58-2.27, p=0.697) in DKD only, and 2.73 (1.90-3.93, p<0.0001) in DKD/NAFLD. Table reports effects of DKD-NAFLD combinations on CV outcomes.

Conclusions: DKD and NAFLD concur increasing mortality and CVD risk in T2D patients. Monitoring and managing DKD and NAFLD is required to prevent CVD and reduce mortality.

graphic
View largeDownload slide
Disclosure

M.Garofolo: Consultant; Novo Nordisk, Employee; Eli Lilly and Company. D.Lucchesi: None. M.Giambalvo: None. M.Capobianco: None. P.Francesconi: None. G.Penno: Advisory Panel; Eli Lilly and Company, Bayer Inc., Consultant; Novo Nordisk, AstraZeneca, Boehringer Ingelheim Inc. S.Del prato: Advisory Panel; Abbott Diagnostics, Altimmune, Amarin Corporation, Applied Therapeutics Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Vertex Pharmaceuticals Incorporated, Novartis, Consultant; A. Menarini Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Sanofi.

© 2023 by the American Diabetes Association
2023
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.