Patients with diabetes are at risk of developing liver fibrosis, suggests a study published in PLoS One.¹ This risk was evident regardless of any underlying liver disease.

Researchers from South Korea selected 2090 subjects, who underwent a health examination at two healthcare centers in Seoul and Suwon in South Korea, in this cross-sectional study to determine the association between diabetes or prediabetes and the risk of liver fibrosis. For this, the participants were categorized into three groups. Patients with fasting blood glucose <100mg/dL and A1c <5.7% were grouped as “no glucose tolerance” (n=889); patients with FPG 100-125 mg/dL and A1c 5.7-6.4% were included in the “prediabetes” group (n=985), while patients with FPG ≥126 mg/dL and A1c ≥6.5% or were being treated with an anti-diabetic drug were categorized as “diabetes” group (n=216). Whether the presence of liver disease had an impact on this association was also investigated. Liver stiffness (LSM) measured using 2D real-time magnetic resonance elastography (MRE) was considered as an indicator of liver fibrosis.

The mean LSM in patients with no glucose intolerance was 2.37 kPa; in prediabetic individuals it was 2.41, while in the diabetic subjects, it was 2.65. The percentage of significant liver fibrosis, marked by LSM value ≥2.97 kPa, was found to increase proportionately with rise in glucose intolerance. In normoglycemic individuals with no glucose intolerance the LSM was 3.1%, while it rose to 4.4% among those with prediabetes and was nearly 17% among those with diabetes. Participants with diabetes were thrice more likely to have significant fibrosis with adjusted odds ratio of 3.02 compared to those in the no glucose intolerance group. However, no such association was observed between prediabetes and no glucose intolerance groups (aOR 1.05). In a subgroup analysis, a correlation between diabetes and significant fibrosis was found regardless of the presence or absence of liver disease. 

These findings suggest diabetes, but not prediabetes, as a risk factor for significant liver fibrosis. This association was observed even in persons without liver disease. Liver fibrosis progresses to cirrhosis with impaired liver function, which is irreversible. There is no turning back the clock then. Liver fibrosis may be silently progressing in many diabetic patients and therefore may be missed. Hence, patients with diabetes should be screened for hepatic fibrosis to avert cirrhosis and resulting mortality in consonance with the 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes, which state that “patients with type 2 diabetes or prediabetes and elevated liver enzymes (ALT) or fatty liver on ultrasound should be evaluated for presence of nonalcoholic steatohepatitis and liver fibrosis”.

Reference

1. Park J, et al. Risk of liver fibrosis in patients with prediabetes and diabetes mellitus. PLoS One. 2022 Jun 2;17(6):e0269070. doi: 10.1371/journal.pone.0269070.