Introduction Over the past thirty years the number of people with diabetes mellitus (DM) has more than doubled globally and the WHO predicts that DM will be the seventh leading cause of death by 2030. DM is a causative factor of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Presently raised alanine transaminase (ALT) is used as a marker for NAFLD however it is recognised that ALT is not a sensitive marker for either diagnosing or assessing the severity of NAFLD. Ultrasound is a better method of disease detection and the degree of fibrosis can be documented using elastography.
Method We aimed to determine the prevalence of NAFLD and extent of liver fibrosis in an unselected population of subjects with DM attending outpatient clinics in secondary care. Secondary endpoints included determining whether there were any differences in ALT levels and liver stiffness scores between subjects with type 1(T1) and type 2(T2)DM. On five separate occasions we attended DM clinics offering fibroscans to patients (pts) waiting to be seen. We also collected data on age, sex, weight, height; liver function tests (LFTs), alcohol intake and type of diabetes.
Results We performed fibroscans on 45 pts; 25 T1DM (15 females (F) age range (AR) 31–67, median age (MA) 42; 10 males (M) AR 22–84, MA 45) and 20 with T2DM (17M; AR23–72, MA54 and 3F;AR 31–58, MA44). All pts consumed less than the government recommended units of alcohol. In the T1DM cohort, median BMI: 27; range19–37, median ALT 23 iu/L; range 12–51 iu/L*,median liver stiffness: 4.8 KPa; range 2.8–11.9 KPa (F: median ALT 19 iu/L, liver stiffness 4.7 KPa; M: median ALT 30 iu/L, liver stiffness 5.2 KPa). One pt (F) had METAVIR stage 4 fibrosis on fibroscan. In the T2DM cohort, the median BMI: 31; range 27–40, median ALT 50 iu/L, range 13–119 iu/L, median liver stiffness: 8.9 KPa, range 4.1–21.3 KPa (F: median ALT 21 iu/L, liver stiffness 6.3 KPa; M: median ALT 55 iu/L, liver stiffness 9.1 KPa). Elevated ALT was documented in 13/20 (65%), median liver stiffness: 11.3 KPa (METAVIR stage 4), none of these pts were known to hepatology services. In this cohort scatterplot analysis demonstrated a positive correlation between ALT level and median liver stiffness.
*Normal range of ALT: M: <40 iu/L, F: <30 iu/L
Conclusion In an unselected asymptomatic cohort of DM pts, 16/45 (35%) had raised ALT levels with a prevalence of 24% of advanced fibrosis in this cohort. Abnormal ALT levels and elevated liver stiffness scores were more common in T2DM pts compared to T1DM pts. This study highlights the importance of early identification of pts with risk factors for NASH, regular monitoring of LFTs, reacting to abnormalities and specialist referral for fibrosis assessment using elastography.
Disclosure of interest None Declared.