149-OR: Liver Health in Adolescents with Youth-Onset Type 2 Diabetes

Introduction: Youth-onset type 2 diabetes (Y-T2D) and metabolic liver disease (MASLD) commonly coexist. MASLD can advance to fibrosis/cirrhosis with no treatments beyond lifestyle intervention. Limited liver data in Y-T2D led us to investigate MASLD in the ST₂OMP study, which will compare metabolic bariatric surgery (MBS) to medical treatment for Y-T2D.

Methods: Liver fat (MRI proton density fat fraction (PDFF), liver stiffness (MR elastography), and ALT (inflammation) were measured in Y-T2D at ST₂OMP enrollment. Linear regression examined differences in liver outcomes adjusted for sex, race/ethnicity, BMI, HbA1c and glucagon-like peptide 1 receptor agonists (GLP-1RA) use.

Results: At baseline, participants (n=56) had mean age 16.6yrs and BMI 43.8 kg/m²; median HbA1c 6.3% and diabetes duration 1.7 yrs. Elevated ALT occurred in 76.4%, PDFF in 89.0% and stiffness in 14.8%. Analyses adjusted for age, BMI and HbA1c (Table), found higher PDFF and ALT in males (vs. females) and in youth not taking GLP-1RA (each p<0.05). Non-Hispanic White youth had the highest stiffness (p<0.05).

Conclusions: MASLD is prevalent in Y-T2D with evidence of inflammation and stiffness. Males had higher measures of fat and inflammation, and non-Hispanic white youth had the highest stiffness. GLP-1RA use may be associated with less fat and inflammation, independent of BMI, but not stiffness. Future ST₂OMP results will compare MASLD outcomes pre- and post-MBS.

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