Clinical Characteristics Of Type 2 Diabetes Mellitus With Nonalcoholic Fatty Liver Disease And Risk Factors Of Liver Fibrosis

Objective:To investigate the clinical characteristics of type 2 diabetes mellitus(T2DM)with nonalcoholic fatty liver disease(NAFLD)and explore the differences between non-obese and obese patients.To analyze the risk factors of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease for the progression of liver fibrosis,and establish a simple predictive model.Methods:A total of 509 patients with T2 DM in Union Hospital of Fujian Medical University from February 2018 to November 2019 were collected,who received their first visit to the National Metabolic Management Center(MMC).All patients underwent abdominal ultrasound examination.We collected the general information such as gender,age,medical and medication history,height,weight,waist circumference,hip circumference,visceral adipose tissue,subcutaneous adipose tissue,the serum biochemical indexes such as fasting blood glucose,2h postprandial blood glucose,glycosylated hemoglobin,fasting c-peptide,2h postprandial c-peptide,triglyceride,cholesterol,uric acid.The information of diet and lifestyle were gathered by the questionnaire of MMC.According to the complication with non-alcoholic fatty liver disease and body mass index(BMI),patients were divided into(1)non-obese control group,(2)non-obese NAFLD group,(3)obesity control group,(4)obese NAFLD group.The differences of general data,blood index,diet and lifestyle among each group were analyzed.The risk factors of liver fibrosis in patients with T2 DM complicated by NAFLD were analyzed by binary logistic regression,and the predictive model was established.Results:1.The Clinical features of T2 DM with NAFLD(1)Comparison of general data: No significant difference was observed in gender,age and course of diabetes among the groups(P>0.05).In terms of medication history,the proportion of lipid-lowering drugs used in the obese NAFLD group was higher than that in the other three groups(P<0.05).Non-obese NAFLD group had higher BMI,waist-hip ratio,VAT and SAT than non-obese control group(P<0.05),while the differences between the obese NAFLD group and obese control group were not statistically significant.The non-obese NAFLD group and the obese NAFLD group showed no difference in VAT/SAT and the rate of liver fibrosis(P>0.05).(2)Comparison of serum biochemical metabolic indexes: Both NAFLD groups had higher fasting blood glucose than their corresponding control groups(P<0.05).Non-obese NAFLD group had higher fasting c-peptide and 2h postprandial c-peptide than non-obese control group(P<0.05).Obese NAFLD group had higher fasting c-peptide than non-obese NAFLD group(P<0.05).Both NAFLD groups had higher TG,HDL-C and GGT than their corresponding control groups(P<0.05),but there were no significant difference between obese NAFLD group and non-obese NAFLD group(P>0.05).Obese NAFLD group had higher ALT,AST,serum uric acid and CRP than non-obese NAFLD group(P<0.05).(3)Comparison of diet and lifestyle: There existed a lower proportion in Non-obese NAFLD of individuals who still had jobs,consumed less vegetables per day and stayed up later than obese NAFLD group(P < 0.05).The proportion of individual with an occupation was lower in non-obese NAFLD group,with less vegetable consumptions.2.Independent risk factors and simple prediction model of T2 DM with NAFLD progressive liver fibrosisThe level of waist circumference,visceral fat thickness,and blood uric acid were significantly higher in the fibrosis group than those in the non-fibrosis group.However,shorter sleep duration was perceived in comparison with the non-fibrosis group(P<0.05).After adjusting for confounding factors by binary logistic regression,visceral adipose tissue and sleep duration were independent risk factors for T2 DM with NAFLD progressive liver fibrosis.A simple predictive scoring model for T2 DM with NAFLD progressive liver fibrosis was established,and the AUC was predicted to be 0.756 for all NAFLD patients in T2 DM,and 0.814 for non-obese NAFLD patients in T2 DM.Conclusions:1.The clinical characteristics of T2 DM with NAFLD include fat accumulation,disorder of glucose and lipid metabolism,elevated levels of liver enzymes and uric acid,and unhealthy diet and lifestyle.2.In the T2 DM patients with NAFLD,the non-obese group had comparable accumulation of visceral fat,the identical glucose and lipid metabolism disorder,and the equivalent possibility of liver fibrosis with the obese group.3.VAT and sleep duration were independent risk factors for T2 DM with NAFLD progressive liver fibrosis.The simple risk score model y=0.057* age +0.015*VAT was established to predict the risk of NAFLD developing liver fibrosis in T2 DM population.The predictive efficacy was better for non-obese patients.When y=4.759 was used to diagnose the liver fibrosis,the sensitivity was 78.4% and the specificity was 77.9%.