Assessment of Hepatobiliary Status and Cardiometabolic Risk Markers among Type 2 Diabetes Mellitus Patients. A Cross-Sectional Study

Abstract

Objective: Previous studies have shown a higher prevalence of non-alcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM), and NAFLD itself is a risk factor for cardiovascular diseases (CVD). With both NAFLD and T2DM, there is a vicious circle of disease worsening, with one disease aggravating the development and progression of the other, thereby predisposing to early CVD events. Hence, we aimed to study the association between hepatobiliary status and cardiometabolic risk among T2DM patients. Material and methods: Eighty two patients with T2DM without any established liver and cardiac disease were recruited for the study. Routine biochemical parameters were measured by an autoanalyzer. Parameters such as triglyceride glucose index (TyG index), lipid pentad index, fatty liver disease index (FLDI) etc. were calculated using the established formulas. HbA1c was estimated using Biorad D10 autoanalyzer. Apolipoprotein B (Apo-B), Apo-A, lipoprotein (a) [Lp(a)], insulin, C-peptide were analyzed using ELISA. Results: Significant positive correlation was seen between cardiometabolic risk biomarkers and hepatobiliary biomarkers and significant negative correlation with total bilirubin and De-Ritis ratio. Through stepwise regression, FLDI was found to be a significant factor in the prediction of lipid pentad index (LPI). LPI, TyG index, FLDI were able to differentiate patients with T2DM based on the gold standard HbA1c values for T2DM diagnosis. Conclusions: Increase in hepatobiliary dysfunction contributes to increased CVD risk in T2DM patients. This study highlights the need for collaborative actions of diabetologists and hepatologists in identifying the people with NAFLD among T2DM patients, who should be targeted with intensive therapy to decrease their risk of future CVD events.