Prevalences of diabetic retinopathy and nephropathy are lower in Korean type 2 diabetic patients with non-alcoholic fatty liver disease.

Abstract

The associations between non-alcoholic fatty liver disease (NAFLD) and chronic vascular complications of type 2 diabetes remain uncertain. We assessed the relationships between NAFLD and chronic vascular complications in patients with type 2 diabetes. Patients with type 2 diabetes (n=929) attending a diabetes clinic of a university hospital were studied retrospectively. Patients who had any clinical evidence of cirrhosis or other causes of chronic liver disease were excluded. Prevalences of chronic microvascular and macrovascular complications were assessed. NAFLD was ascertained by ultrasonography. The prevalence of NAFLD in patients with type 2 diabetes was 63.3%. The prevalences of diabetic retinopathy and nephropathy were significantly lower in patients with NAFLD than those without NAFLD (33.0 vs 70.2%, P<0.001; 29.3 vs 37.1%, P=0.007, respectively), whereas no difference was found in the prevalence of diabetic neuropathy. The prevalence of diabetic macrovascular complications was lower in type 2 diabetic patients with NAFLD than those without NAFLD (9.2 vs 14.7%, P=0.008). After adjustment for confounding factors, such as age, sex, glycated hemoglobin, fasting serum C-peptide, diabetic duration, body mass index and hypertension, NAFLD remained significantly associated with a lower odds ratio (OR) of diabetic retinopathy (OR 0.440, 95% confidence interval 0.255-0.757, P=0.003) and nephropathy, (OR 0.541, 95% confidence interval 0.358-0.817, P=0.003). In contrast, NAFLD was not significantly associated with macrovascular complications after adjustment for confounding factors. These results suggest that NAFLD is inversely associated with prevalences of diabetic retinopathy and nephropathy in Korean patients with type 2 diabetes.