Introduction and Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with cirrhosis, cardiovascular disease (CVD) and increased mortality in type 2 diabetes. Data in type 1 diabetes (T1D) are limited. We examined the prevalence of and risk factors for MASLD in adults with T1D in the Epidemiology of Diabetes Interventions and Complications (EDIC) study.Methods: Hepatic steatosis (controlled attenuation parameter [CAP] score ≥274 dB/m) and clinically significant fibrosis (liver stiffness measurement ≥8.0 kPa) were evaluated in 746 participants by vibration-controlled transient elastography (FibroScan®). Clinical signs of peripheral neuropathy were defined as a score >2 on the Michigan Neuropathy Screening Instrument. CVD events were adjudicated using standardized measures.Results: Current mean age and T1D duration were 64 and 43 yrs, respectively; 53% were male; mean BMI was 29.1 kg/m2 and HbA1c 7.2%. Prevalence of steatosis was 38% (8% mild, CAP 274-287; 8% moderate, 288-302; 22% severe, ≥302) and 12% had fibrosis. Male sex, higher BMI, mean chronic HbA1c and triglycerides, and lower HDL-C were associated with higher risk of both steatosis and fibrosis. In age and sex adjusted models, neuropathy was associated with higher odds of steatosis (OR [95% CI] 1.66 [1.21, 2.28]), while CVD and mean chronic HbA1c were associated with higher odds of fibrosis (1.86 [1.05, 3.29] and 1.47 [1.12, 1.93] per 1% increase in HbA1c, respectively). Only the association of fibrosis with mean chronic HbA1c (1.37 [1.02, 1.83]) remained significant after further BMI adjustment.Conclusion: MASLD affects over one-third of the individuals with long-duration T1D included in this study; 12% have clinically significant fibrosis, a predictor of hepatic decompensation, mortality, and liver cancer. These findings support the ADA recommendations to screen for MASLD in T1D in the face of obesity and other risk factors, and highlight the association between glycemic control and fibrosis.
K. Cusi: Research Support; Boehringer-Ingelheim, Echosens, Inventiva, Perspectum Ltd, LabCorp. Consultant; Arrowhead Pharmaceuticals, Inc, AstraZeneca, TERNS Pharmaceuticals, 89bio, Inc, Boehringer-Ingelheim, Eli Lilly and Company, Novo Nordisk A/S, Sagimet Biosciences. V.R. Trapani: None. H. Karanchi: None. B.H. Braffett: None. I. Bebu: None. R. Gubitosi-Klug: None. M. Bott: None. G.M. Lorenzi: None. V. Arends: None. C.K. Lovell: None. D.M. Nathan: Advisory Panel; Lexicon Pharmaceuticals, Inc. A. Sanchez: Advisory Panel; Madrigal Pharmaceuticals, Inc, IPSEN. Research Support; AbbVie Inc, Gilead Sciences, Inc, Takeda Pharmaceutical Company, Merck & Co., Inc, Inventiva Pharma, Boehringer-Ingelheim. W. Sivitz: None.
National Institutes of Health (U01 DK094176 and U01 DK094157)
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