- Type 2 diabetes mellitus (T2DM) is a strong predictor of liver disease progression in patients with nonalcoholic fatty liver disease (NAFLD) and the more advanced nonalcoholic steatohepatitis (NASH).
Why this matters
- NAFLD remains underdiagnosed, and findings warrant close monitoring of liver function in patients with T2DM.
- 18,782,281 adults in 4 primary care databases in the UK, Netherlands, Italy, and Spain.
- 136,703 patients with NAFLD/NASH were matched with up to 100 non-NAFLD control patients by age, sex, practice site, and time of most recent visit.
- Median follow-up, 3.3 years.
- Funding: European Research Council, National Institute for Health Research.
- Patients with NAFLD/NASH were more likely to have diabetes (19.8% vs 9.6%), hypertension (42.2% vs 29.6%), and obesity (36.0% vs 15.4%) than matched controls.
- For patients with NAFLD/NASH, incidence (per 1000 person-years) was 0.76 (95% CI, 0.46-2.32) for cirrhosis and 0.3 (95% CI, 0.26-0.60) for hepatocellular carcinoma (HCC).
- Compared with controls, patients with NAFLD/NASH had more than:
- Quadrupled risk for cirrhosis (pooled HR=4.73; 95% CI, 2.43-9.19).
- Tripled risk for HCC (pooled HR=3.51; 95% CI, 1.72-7.16).
- Risks were significantly higher with high vs indeterminate/low fibrosis scores.
- In patients with NAFLD/NASH, baseline T2DM was the strongest predictor of cirrhosis/HCC (HR=2.3; 95% CI, 1.9-2.78).
- Reliance on diagnostic codes, noninvasive liver assessments.