Introduction Diabetes mellitus (DM) is a recognised risk factor for the development of non-alcoholic fatty liver disease (NAFLD). Both entities are increasingly recognised to be different manifestations of a wide spectrum of metabolic syndrome phenotypes.
Our study aims to determine whether incidental abnormal liver function tests (LFT) precede the diagnosis of diabetes mellitus in patients without an underlying liver diagnosis.
Method We identified patients with a diagnosis of diabetes mellitus who attend the same large primary care centre in Newport, South Wales. Data on age at diagnosis, gender and date of diagnosis of diabetes mellitus were extracted from the primary care records. This was linked to secondary care records to extract liver function tests available in the last twenty years.
GP and outpatient clinic letters were carefully examined and patients with known liver disease preceding diagnosis of diabetes were excluded, as were those with other explainable causes for liver function derangement. The resulting database was analysed using the Statistical Package for the Social Sciences (SPSS 23.0, IBM Corp., Armonk, New York, USA).
Results A total of 561 patients were identified, of whom 31 (6%) had type 1 DM and 530 (94%) had type 2 DM. Mean age (± standard deviation) at the time of diagnosis of Type 2 DM was 53 (±19) years, with 305 (54%) being male. Out of this group, 448 patients (80%) had liver function tests checked prior to their diagnosis of DM. Of those, a total of 133 patients (24%) had any preceding LFT abnormality, 100 (18%) in ALT and 58 (10%) in ALP.
The mean ALT derangement was 81 i.u./l (±38 i.u./l) in those with abnormal LFTs recorded prior to diagnosis of diabetes. The mean time (± standard error of the mean) from recorded ALT abnormality to diagnosis of DM was 873 (±103) days, and from ALP to DM was 655 (±84) days.
Conclusion Our results suggest that incidental abnormalities in LFT (in the absence of diagnosed liver disease) are associated with a subsequent diagnosis of diabetes mellitus and may represent an earlier manifestation of a spectrum of metabolic syndromes.
There may be a role for utilising incidental abnormalities in LFTs to promote early detection of diabetes mellitus in asymptomatic individuals, particularly those that fit the profile of a metabolic syndrome patient.
Further follow-up is required to ascertain if such knowledge may impact on both the diagnosis of diabetes and/or NAFLD in such individuals.
Disclosure of Interest None Declared
- liver function tests