Liver screening recommended for type 2 diabetes patients

Last Updated: 2015-05-01

By Larry Hand

NEW YORK (Reuters Health) - People with type 2 diabetes who also are obese and have dyslipidemia should be considered for screening for non-alcoholic fatty liver disease (NAFLD), according to researchers from China.

Because good data are lacking, current guidelines disagree on whether or not to recommend NAFLD screening in diabetics. To gain further insight, the Chinese team used a quick, non-invasive technique called transient elastography (FibroScan from Echosens, Paris, France) to screen nearly 2,500 consecutive diabetes patients 18 years or older.

The patients had a mean age of 61, and just over half were male. More than three-quarters underwent complete diabetes complication screening, and nearly all of those had a reliable liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) value.

More than 72% of the patients had increased CAP values (>=222 dB/m), suggestive of NAFLD, Dr. Vincent Wai-Sun Wong from the Chinese University of Hong Kong and colleagues report in Gut, online April 14.

The number of patients with steatosis indicated by CAP score came to 92 (5.1%), 533 (29.6%), and 684 (38.0%) for grades 1, 2, and 3, respectively.

Median LSM by the M probe came to 6.3 kilopascals (kPa), and 17.1% of patients had values of 9.6 kPa or higher, which is suggestive of advanced fibrosis or cirrhosis, the researchers say.

Among 114 patients who failed the M probe but had reliable XL probe examination, 31 had LSM of 11.0 kPa or higher, which is suggestive of cirrhosis.

Using multivariable analysis, the researchers found increased CAP of 222 dB/m or higher was associated with several factors, including higher body mass index (BMI), female gender, triglycerides, fasting plasma glucose, and not using insulin.

They found increased LSM was linked with longer duration of diabetes, higher BMI, increased alanine aminotransferase and spot urine albumin:creatinine ratio, and lower HDL cholesterol.

Of 94 patients who underwent liver biopsy, about half had advanced fibrosis or cirrhosis. The positive predictive value and negative predictive value of increased LSM to detect histological F3-4 disease were 59% and 84%, respectively.

"Diabetic patients have a high prevalence of NAFLD and advanced fibrosis," the researchers conclude. "Those with obesity and dyslipidaemia are at particularly high risk and may be the target for liver assessment. Our data support screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes."

"Although FibroScan is easy to perform, it is unlikely that clinicians can apply it to all diabetic patients because of the large number of patients and the availability of assessment," they note. "Therefore, it is important to identify patients at risk of NAFLD and advanced liver disease."

In a sidebar, they add: "FibroScan is a reasonable initial assessment for patients with type 2 diabetes. However, its accuracy does not allow confident diagnosis of advanced disease. Further improvements in noninvasive assessment of liver fibrosis are needed."

The Research Grants Council of the Hong Kong Special Administrative Region supported the study.

Dr. Wong, who like two of his co-authors has served as a speaker for Echosens, did not respond to a request for comment.

SOURCE: http://bit.ly/1dBevFw

Gut 2015.