1104-P: Prevalence and Clinical Determinants of Nonalcoholic Fatty Liver Disease by Liver Scores in Adults with T1DM

Abstract

NAFLD is common in diabetes, however the prevalence and clinical features of NAFLD in T1DM are not well defined. A retrospective, unicenter, cross-sectional analysis was performed of adults with T1DM at our institution from 2015-2018. The hepatic steatosis index (HSI) , Framingham steatosis index (FSI) , FIB-4 index, and AST-to-platelet ratio index (APRI) were calculated and associated with clinical parameters. We identified 447 patients, 38.6 ± 14.5 yrs, 54% (N=241) female, HgA1c 8.4 ± 1.8 %, BMI 28 ± 5.9 kg/m2. The prevalence of NAFLD by HSI ≥36 was 61% (N=271) and by FSI ≥23 was 52% (N=230) . The presence of advanced fibrosis by APRI >0.7 was 4% (N=18) and FIB-4 >2.67 was 4% (N=8 of 221 included) . Patients with metabolic syndrome (N=103, 23%) were significantly more likely to have NAFLD by HSI (86% vs. 53%, p<0.001) and FSI (93% vs. 39%, p<0.001) . Compared to BMI <30, nearly all patients with BMI ≥30 (N=125, 28%) had NAFLD by HSI (100% vs. 45%, p<0.001) and FSI (98% vs. 34%, p<0.001) . Older age (44 vs. 33 yrs) , HTN, HLD, cardiovascular disease, and higher TG/HDL ratio (median 1.8 vs. 1.1) were associated with FSI ≥23. Older age (41 vs. 30 years) , HTN, HLD, and lower HDL (58 vs. 66 mg/dL) were associated with HSI ≥36. On multivariable analysis, older age, metabolic syndrome features, and BMI were associated with higher HSI and FSI. HgA1c was inversely related to HSI. Twenty of 94 patients (21%) with abdominal imaging reported hepatic steatosis; 8 (2%) had hepatology referral and 6 (1%) had a liver biopsy. Of 447 patients, GLP-1 agonist was prescribed in 5% (N=24) and thiazolidinedione in 4% (N=16) . Liver scores indicating liver steatosis but not fibrosis is common in adults with T1DM with obesity and/or metabolic syndrome, and is associated with older age, HTN, HLD, and high TG/HDL. NAFLD is overlooked; only 21% of patients had any liver imaging and only 1% had a liver biopsy. Thiazolidinedione and GLP-1 agents are effective at preventing and reversing NAFLD damage but appear underutilized in the T1DM population. Disclosure M.D.Lundholm: None. J.F.Bena: None. K.Zhou: None. Y.Tsushima: None. S.Kashyap: Advisory Panel; Fractyl Health, Inc., GI Dynamics, Research Support; Janssen Pharmaceuticals, Inc.