How Often Do We Find Steatosis and Significant Fibrosis in Type 2 Diabetes Mellitius Patients

Abstract

The aim of the present study was to assess the severity of liver fibrosis and steatosis in a cohort of type II diabetic patients, using non-invasive methods:Transient Elastography (TE) and Controlled Attenuation Parameter (CAP). The study included 354 type II diabetic patients,who were prospectively randomized (every first 6 patients who were referred to the Metabolic Disease Outpatient Clinic on a consultation day), evaluated in the same session by means of TE and CAP(FibroScan EchoSens) to assess both liver fibrosis and steatosis. Each patient was evaluated for the presence of viral hepatitis (B, C) and an AUDIT-C score was performed to exclude alcohol abuse. Reliable liver stiffness measurements (LSM) were defined as the median value of 10 LSM with an IQR/median <30%. For TE and CAP, M and XL probes were used. A cut-off value of 8.2 kPa [1] was used to define severe fibrosis (F≥3). For differentiation between stages of steatosis we used the following cut-off values [2]: S2 (moderate) - 255 db/m, S3 (severe) - 290 db/m. Out of 354 diabetic screened we excluded those with associated viral hepatitis, those with an AUDIT-C score ≥8 and those with unreliable LSM. The final analysis included 239 subjects (59.4% women,40.6% men, mean age 60.4±9.3; BMI=31.8± 6.1 kg/m2) with reliable LSM. Accordingly to BMI 10.8 % had normal weight, 26.4% were overweight and 62.8% were obese. Moderate and severe steatosis by means of CAP was found in 18.4% and 69.5 % cases respectively. Severe fibrosis was detected by means of TE (LSM≥8.2 kPa) in 29.3% (70/239) of subjects. In our group, 87.9 % of diabetic patients had moderate and severe steatosis by CAP and 29.3 % of them had severe fibrosis (TE ≥ 8.2 kPa), suggesting the need for their systematical assessment.