Undiagnosed liver disease common among US adults with type 2 diabetes
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Among U.S. adults with type 2 diabetes attending primary care and endocrinology clinics, less than 40% of those found to have liver fibrosis had elevated aspartate aminotransferase and alanine aminotransferase, according to study data.
Clinicians treating patients with type 2 diabetes should add imaging to laboratory testing to screen for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, according to Romina Lomonaco, MD, assistant professor of medicine in the division of endocrinology, diabetes and metabolism at the University of Florida, and colleagues.
“Patients with diabetes have higher prevalence rates of significant liver fibrosis and a greater chance of disease progression to cirrhosis and [hepatocellular carcinoma] than the general population,” Lomonaco told Healio. “Liver fibrosis is the single most important histological finding determining progression. The FibroScan (Echosens) is an amenable tool for point-of-care screening for fibrosis and steatosis in settings beyond hepatology clinics; however, this approach has never been systematically tested before in patients with type 2 diabetes in the U.S. In addition, most studies have been done in Asian and European populations.”
The researchers recruited 564 adults with type 2 diabetes (mean age, 60 years; 56% women; 61% white; mean HbA1c 7.5%; mean BMI, 33.3 kg/m2) attending internal medicine, family medicine and endocrinology clinics. Participants — who had not received a prior diagnosis of nonalcoholic fatty liver disease — underwent laboratory testing for liver fibrosis, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST to platelet ratio index and fibrosis-4 index; vibration-controlled transient elastography imaging to screen for fibrosis; and controlled attenuation parameter to assess steatosis. Participants suspected of having substantial fibrosis (stage F2 or higher) based on the testing underwent liver biopsy.
Mean AST was 21 U/L and mean ALT was 24 U/L. Based on vibration-controlled transient elastography, 7% of participants had fibrosis stage F1, 6% F2, 6% F3 and 3% F4. In addition, steatosis assessed by controlled attenuation parameter score was mild for 9% of participants, moderate for 8% and severe for 53%. Among those with any steatosis, 86% had normal AST and 75% had normal ALT; and among those with any fibrosis, 71% had normal AST and 62% had normal ALT.
BMI was strongly correlated with steatosis and fibrosis, according to the researchers.
“One in six patients with type 2 diabetes seen any day in the clinic for usual care have advanced fibrosis and are at risk of cirrhosis,” Kenneth Cusi, MD, FACP, FACE, chief of the division of endocrinology, diabetes and metabolism at University of Florida, an Endocrine Today Editorial Board Member and a researcher involved in the study, told Healio. “What are you going to do about it? Are you going to let them go undiagnosed and untreated?”
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Lomonaco R, et al. 2309-PUB. Presented at: American Diabetes Association Scientific Sessions; June 12-16, 2020; (virtual meeting).
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