TLM 2022: "Accelerator" real hammer! Type 2 diabetes can speed up the progression of NAFLD fibrosis by 2 years!

According to new findings presented at the annual meeting of the American Association for the Study of Liver Diseases, fibrosis progression rates are higher
in patients with nonalcoholic fatty liver disease (NAFLD) who also have diabetes.

Daniel Huang, a visiting scholar at the NAFLD Research Center at the University of California, San Diego (UCSD) and a transplant hepatologist at the National University Hospital of Singapore, said NAFLD patients with type 2 diabetes progress to a stage about every 6 years, while patients without diabetes progress to a stage
about every 8 years.

"The fibrotic stage is a major determinant
of liver-related outcomes and overall mortality in NAFLD," he said.
Liver fibrosis in people with NASH (nonalcoholic steatohepatitis) develops in
stages approximately every 7 years.

He noted that recent UCSD data suggest that about 14 percent of people over the age of 50 with type 2 diabetes have NAFLD with advanced fibrosis
.
Previous studies have shown that diabetes is associated with higher rates of advanced fibrosis, cirrhosis, and hepatocellular carcinoma, but there are limited
data on whether fibrosis progression rates are higher in people with diabetes.

1.
Research results

Huang and colleagues conducted a multicenter, multi-ethnic, prospective cohort study within the NASH Clinical Research Network consortium to examine fibrosis progression rates and fibrosis resolution rates
in patients with or without diabetes.

Clinical and laboratory data were obtained at enrollment and prospectively at 48-week intervals and recorded
at the time of any liver biopsy.
Fibrosis progression and resolution rates are defined as the change in fibrosis stages over time between biopsies, measured in years
.

The study included 447 adult participants with NAFLD: 208 with type 2 diabetes and 239 with non-diabetes
.
The mean age was 51 years and the average body mass index was 34.
7
.
People with diabetes are more likely to be older, female, and have metabolic syndrome, NASH, and higher fibrotic stages
.

Notably, the median HbA1c in diabetics was 6.
8%, indicating fairly good glycemic control in this cohort
.
The median time between biopsies was 3.
3 years
.

Overall, 151 participants (34%) experienced fibrosis progression, which is the primary finding
.
In the secondary outcome, 102 participants (23%) experienced resolution of fibrosis
.
The remaining 194 participants (43%) had no change in fibrosis stage
.
About 26% of people with type 2 diabetes progressed to advanced fibrosis, compared with 14.
1%
of people with non-diabetes.

Among all patients with fibrosis progression, the rate was 0.
15 stages per year, and the average rate of progression was 6.
7 years per stage
.
For patients with diabetes, the rate of progression was significantly higher, at 0.
17 stages per year, compared to 0.
13 stages
per year for patients without diabetes.
This means that people with diabetes progressed an average of one stage
over a period of 5.
9 years and non-diabetics over a period of 7.
7 years.

In contrast, regression rates were similar at baseline for diabetic and non-diabetic patients, with a regression rate of -0.
13 stage/year in patients with diabetes and -0.
14 stages/year
in non-diabetics.
Similar results translate into an average time of 7.
7 years for a stage of regression in people with diabetes and 7.
1 years
for people without diabetes.

Type 2 diabetes is an independent predictor of NAFLD fibrosis progression in unadjusted and multivariate adjusted models, including baseline fibrosis stage
.
In addition, patients with diabetes had a significantly higher
cumulative incidence of fibrosis progression at four years (23 versus 19 percent), eight years (59 versus 49 percent), and 12 years (93 versus 76 percent).

When using a cut-off value of 7%, the research team did not find a significant difference
in HbA1c as a predictor of fibrosis progression.

Huang said: "Poor blood sugar control may further accelerate fibrosis, but we need research to verify this
.
" These data have important implications
for clinical practice and clinical trial design.
People with NAFLD and diabetes may need to be monitored for disease progression
more frequently.
”

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