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Insulin monitoring in NAFLD could prevent progression to diabetes
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LAS VEGAS — Patients with non-alcoholic fatty liver disease who do not have diabetes do show a prevalence of insulin resistance and hyperinsulinemia and may benefit from prevention strategies and treatment intervention to halt progression to diabetes and its complications and also improve steatosis, according to data presented here.
“The goal is intervene early and to slow the progression of type 2 diabetes and cardiovascular disease,” Leah Folb, MD, of Weill Cornell Medical College and Houston Methodist Hospital, said at the AACE 23rd Annual Scientific & Clinical Congress. “Non-alcoholic fatty liver disease is associated with atherosclerosis of the liver. Hyperinsulinemia is present early and can be a target to the prevention of progression to NASH, diabetes and cardiovascular disease.”
Leah Folb
Folb and colleagues reviewed charts from 98 patients (men, 40; women, 58) with non-alcoholic fatty liver disease (NAFLD) but without diabetes who were consecutively referred to the Metabolic Liver Clinic between 2010 and 2013.
The researchers assessed glucoregulatory status based on HbA1c and by oral glucose tolerance test (OGTT) with glucose and insulin measured at 0, 30, 60, 90 and 120 minutes, plus c-peptide and proinsulin measured at 0 and 30 minutes. Spearman correlation coefficient was used to measure the association between metabolic parameters and nonalcoholic steatohepatitis (NASH) scores.
The most compelling association was steatosis score vs. BMI (P<.0001). Additional significant associations were: insulin resistance as measured by homeostatic model assessment-insulin resistance (HOMA-IR) vs. BMI (P=.02), beta-cell function as measured by HOMA-B vs. BMI (P=.01) and glucose level as measured by steatosis score vs. HbA1c (P=.003). Multivariate analysis showed the only significant correlation in women was steatosis score vs. HbA1c.
The researchers recently received approval to develop a registry that will monitor the natural history of insulin resistance in patients, including OGGTs and NASH scores. Folb also said they are eager to assess the response to interventions such as pioglitazone and vitamin E.
For More Information:
Folb L. Abstract 304. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.
Disclosures: Folb reports no relevant financial disclosures.
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Leann Olansky, MD
An insulin sensitizer such as pioglitazone should be considered in NAFLD cases and, additionally, vitamin E has been shown to be beneficial in NASH.
There was a trial of pioglitazone vs. vitamin E (800 units) as compared to placebo in NASH reported in 2010 (Sunyal AJ. NEJM. 2010;doi:10.1056/NEJMoa0907929). While pioglitazone helped in the stages prior to fibrosis, it did not reduce fibrosis whereas vitamin E did reduce fibrosis.
Thiazolidinediones, such as pioglitazone and rosiglitazone, do reduce fat in the liver which is the first step in NASH and that is why it was suggested as an approach to protecting the liver in patient with fatty liver or NASH.
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