Multiple Daily Injections Versus Continuous Subcutaneous Insulin Infusion: Differential MAFLD Risks in Patients With Type 1 Diabetes?

Non-alcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction-associated fatty liver disease (MAFLD), affects 30% of adults worldwide and up to 40% of those with type 1 diabetes mellitus (T1DM)
PUBLISHED IN: Diabetes & Metabolism (September 2023)


When present together, NAFLD and T1DM are known to increase the risk of developing more severe MAFLD subtypes and diabetes-associated vascular complications. NAFLD/MAFLD and T1DM’s intricate relationship may be mediated by peripheral and hepatic insulin resistance as well as chronic hyperglycemia, which both drive and derive from excessive hepatic and intra-abdominal fat deposition. Importantly, life-long insulin administration, the primary treatment for T1DM, may induce iatrogenic peripheral hyperinsulinemia. As such, associated therapeutic modalities may contribute to long-term and tissue-specific disruptions in insulin signalling as well as MAFLD-promoting ectopic fat deposition.

This retrospective, multicentre, and cross-sectional study aimed to investigate the association between two insulin administration modalities, i.e. multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and the risk of MAFLD in adults with T1DM. The latter was measured non-invasively using hepatic steatosis and fibrosis-4 indices.


Compared to those with MDI, patients administered with CSII were more likely to be younger, possess better glycaemic control, lower plasma triglycerides, higher estimated glomerular filtration rate, and lower serum liver enzymes. The prevalence of MAFLD without fibrosis remained the same for both groups. However, when compared with the MDI group, patients with CSII were more likely to have a significantly (∼70%-) lower risk of MAFLD without fibrosis. This association persisted after stratifying by median body mass index, sex distribution, or mediation duration of T1DM, but failed to retain significance after adjusting for age, haemoglobin A1c, and other potential confounding factors. Ultimately, no significant difference in MAFLD prevalence with or without coexisting fibrosis between MDI and CSII therapies was found to exist.

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S Duarte, BSc

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