Associação entre o controlo glicémico e risco de doença esteatótica hepática associada a disfunção metabólica na diabetes mellitus tipo 1

Abstract

Background/Objective: The really impact of glycemic control and insulin resistance on Metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 1 diabetes (T1D) remains to be clarified. The aim of this study was to assess the prevalence of steatosis and advanced hepatic fibrosis through non-invasive scores in patients with T1D, and to unravel the associations between glycemic control, insulin resistance, diabetes features, and microvascular complications with the risk for liver steatosis and fibrosis. Methods: We performed a unicentric cross-sectional study of a sample of adult patients with T1D, using a Freestyle Libre(c) CGM. Hepatic Steatosis Index (HSI) and FIB-4 were used as predictors of hepatic steatosis and fibrosis, respectively. We conducted a linear regression analysis to assess the associations aforementioned.

Results: The mean age of the study population was 35.5±12.1 years, and the median diabetes duration was 16.3±10.0 years. The glucose management indicator, time above range and HbA1c were found to have a trend for a positive association with HSI. Estimated glucose disposal rate and time below range were negatively associated with HSI levels. Diabetes duration was positively associated with the logarithm of FIB-4.

Conclusions: A higher risk for liver steatosis was consistently linked to poorer glycemic control, evidenced by higher levels of GMI, TAR and HbA1c, and higher insulin resistance with lower levels of eGDR. A higher TBR was associated with a lower steatosis risk. A prolonged diabetes duration contributed to an increased risk of liver fibrosis. These findings underscore the intricate interplay of glycemic parameters with hepatic outcomes in this population.