Clinical study of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

Abstract

Introduction: Hepatic steatosis may range from a 'benign' indolent deposition of fat to severe lipotoxicity-induced steatohepatitis with necrosis inflammation known as nonalcoholic steatohepatitis (NASH)].NASH is an overlooked complication of Type 2 diabetes mellitus (T2DM) that if missed may carry serious long-term consequences. Aim: To study the prevalence of Nonalcoholic fatty liver disease and Nonalcoholic steatohepatitis in patients with Type 2 Diabetes Mellitus. Materials and methods: This is prospective observational study was conducted on a total of 90 patients, aged above 40yrs with type 2 diabetes mellitus. Patients were subjected to physical examination and laboratory investigations.
Fatty liver by Ultrasonography & various other relevant factors were measured in all study subjects. Based on USG, patients were divided into two groups one is NAFLD group-altered echo texture of the liver parenchyma and normal liver group. Results: The prevalence of NAFLD is high (68.9%) amongst T2DM patients affecting 59.7% males and 40.3% females. Age of the patient and duration of diabetes did not have a significant difference on the incidence of NAFLD. 78% of the patients in NAFLD group had a BMI > 25 kg/m2 which showed that overweight in combination with T2DM increases the prevalence of NAFLD. HbA1C, FBS and PLBS levels in the NAFLD group were significantly higher than the non NAFLD group which showed hyperglycemia increases the risk of developing NAFLD. Insulin resistance was higher among the NAFLD group (P value -0.04, P value -0.02) which indicates that it plays a crucial role in the pathogenesis of NAFLD. 96% of the patients in the NAFLD group had dyslipidemia with 41.9% of patients having hypertriglyceridemia. Serum transaminases were elevated in 58.3% of the NAFLD group with AST: ALT>1 among the 20 patients who underwent liver biopsy fatty liver was seen in 75%, NASH in 15% and fibrosis in 10%. Conclusion: The
prevalence of NAFLD is high amongst T2DM patients and, considering this risk, NAFLD should be actively sought out and treated in patients with diabetes.