DETERMINANTS OF SIGNIFICANT HEPATIC FIBROSIS IN TYPE 2 DIABETES PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IN SOUTH INDIA.

Abstract

Introduction: Non-alcoholic fatty liver disease is more prevalent among type 2 diabetes(T2D). Apart from liver related morbidity and mortality, fatty liver is associated with increased risk for cardiovascular disease. Severity of hepatic brosis correlates with poor outcome. Early diagnosis and treatment will improve the quality of life. Transient elastography (TE) is a validated tool for assessment of severity of brosis. We estimate the proportion of patients with signicant brosis and its determinants using TE in south india. Methods: Hospital based prospective cross sectional study was conducted among type 2 diabetes patients with ultrasound abdomen reported as fatty liver over the study period of one year. Exclusion criteria was applied to rene the study population to asymptomatic non alcoholic fatty liver disease patients. TE examination was done and signicant hepatic brosis (≥ F2 = 7.1 to 8.7kpa) was correlated with various blood parameters and anthropometrics. Results: 140 patients were selected from 781 type 2 diabetes population. Proportion of signicant brosis (≥ F2) was 47.1 percent. All patients except one were either obese 59(89.4%) or overweight 6(9.1%) in the subgroup of signicant brosis. T2D patients with uncontrolled HbA1c levels had more signicant brosis (p = 0.02) than controlled patients. Liver enzymes (AST/ALT) and lipid prole measurements do not correlate with signicant brosis. Ultrasound abdomen imaging fails to detect signicant brosis in two third of cases (p=0.002). Conclusion: Nearly half of type 2 diabetes with NAFLD in south India had signicant hepatic brosis. Higher BMI (> 30) and poor glycemic control were key determinants of signicant hepatic brosis. This subset of T2D patients warrant TE screening study