Introduction People with type 2 diabetes mellitus (T2DM) have a higher prevalence of and higher mortality rates from liver-associated disease than the non-diabetic population of equivalent age. Early identification of liver disease followed by appropriate surveillance and intervention should be beneficial to the expanding population of older people with T2DM. We aimed to determine the prevalence and progression of hepatic fibrosis in a representative sample of older adults with T2DM.
Methods 1066 participants of the Edinburgh Type 2 Diabetes Study, a large, randomly-selected population of patients with T2DM aged 60–75 years were invited to assessment on two occasions. At baseline, the Enhanced Liver Fibrosis Panel (ELF) was measured and demographics and diabetes history were recorded. ELF was repeated approximately 3 years later. The presence of fibrosis was determined as: none/mild <7.7, moderate 7.7–<9.8, severe ≥9.8. Fibrosis progression was investigated for association with demographics, diabetes history and alcohol intake using logistic regression.
Results Average follow-up was 2.7 years. At baseline (n=530), 3.1% subjects had no/mild fibrosis, 85.1% moderate fibrosis and 11.9% severe fibrosis. Follow-up prevalences (n=806) were 1.9%, 79.3%, and 18.9% respectively. 489 subjects had both baseline and follow-up ELF results. 61 (12.5%) patients progressed to the most severe fibrosis stage between baseline and follow-up. None of the factors investigated were independently associated with progression to severe fibrosis: age, sex, social deprivation, diabetes-related factors (fasting glucose, HbA1c, diabetes duration, treatment type or location) or alcohol use.
Conclusion These preliminary data suggest that considerable hepatic fibrosis is present in older patients with T2DM. ELF is well validated for diagnosing severe hepatic fibrosis and it is of concern that in <3 years, almost 13% of patients progressed to this level. Further work is planned to determine factors affecting progression and to develop prognostic models for the development of hepatic fibrosis in people with T2DM.
Competing interests None declared.
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