The relationship between type 2 diabetes (T2D), nonalcoholic fatty liver disease (NAFLD), and liver fibrosis is well-known. Recent research has also confirmed that patients with elevated hemoglobin A1c (HbA1c) levels possess a concomitant rise in liver fibrosis. However, the impact of T2D-related complications on fibrosis levels, independently of HbA1c, remains clinically unexplored. Breaching this knowledge gap may present primary care clinicians with the tools to effectively triage diabetic patients at greatest risk for liver-related complications. This would further narrow targets for screening, ultimately improving uptake in the primary care setting.
The aim of this study was to investigate the relationship between T2D-related complications (diabetic nephropathy, retinopathy, or neuropathy) and the degree of liver fibrosis measured using the fibrosis-4 (FIB-4) index.
T2D complications were found to be associated with a significantly higher degree of FIB-4-measured fibrosis. Indeed, primary care patients with T2D complications were at a 4.5x greater risk of developing fibrosis, independently of HbA1c levels. FIB-4 was thus highlighted as a potent initial screening and stratification modality able to reliably identify diabetic patients with the highest fibrosis risk. Considering FIB-4’s low cost, it may be especially effective in resource-limited settings without advanced non-invasive tools for fibrosis staging and/or widely available hepatology consultations. Patients with T2D and in particular those with complications may thus benefit from the implementation of non-invasive liver fibrosis evaluations (e.g. FIB-4) into their systematic T2D screening protocols.