Epidemiology of Metabolic Dysfunction-Associated Fatty Liver Disease in Type 2 Diabetes Mellitus and Effects of Antiglycemic Therapy on Liver Fibrosis: A Retrospective Study

Muhammad Imran Butt, Gaurav Puri, Kathryn Berkman, Simon Ryder, Joshua Knowles, Muhammad Asif Shahzad, Muhammad Amer Malik, Noa Shalev, Jo Sexton


Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a globally prevalent and multifaceted liver disorder, closely linked to metabolic conditions such as obesity, type 2 diabetes mellitus (T2DM), dyslipidemia and hypertension. The coexistence of MAFLD and T2DM poses substantial health challenges due to their mutual impact on disease progression and prognosis, thereby augmenting the susceptibility to developing cirrhosis and hepatocellular carcinoma (HCC). Some antiglycemic therapies may improve hepatic steatosis and liver histology. The aim of the study was to elucidate MAFLD prevalence, impact of T2DM and other metabolic risk factors on liver stiffness measurement (LSM), correlation of MAFLD with chronic kidney disease (CKD) and ischemic heart disease (IHD) and the influence of antiglycemic medications on LSM, utilizing data derived from fibroscan results.

Methods: A retrospective analysis of electronic health records was conducted encompassing patients who underwent fibroscan assessments at an Australian Hospital from January 1, 2022 to March 31, 2023. The inclusion criteria for MAFLD comprised a controlled attenuation parameter (CAP) score 248 dB along with metabolic dysfunction. During the demographic analysis, patients were stratified on the basis of presence or absence of T2DM while excluding patients with type 1 diabetes mellitus (T1DM) and other potential causes of hepatic steatosis. Linear regression analysis was employed to identify factors associated with LSM scores < 8 or > 8 kPa, indicative of clinically significant fibrosis. Comprehensive medication data were retrospectively extracted from electronic charts and cross-verified with general practitioner medical records.

Results: Among 1,129 participants who underwent fibroscan evaluation, 437 (38.71%) individuals had MAFLD. Statistical evidence demonstrated a significant association between T2DM and MAFLD (P < 0.001), revealing a 4.81-fold increase in the odds of MAFLD, accompanied by a 31% higher LSM (P < 0.001). Furthermore, a robust correlation was observed between MAFLD and CKD (3.38-fold increase in odds, P < 0.001), as well as IHD (2.10-fold increase in odds, P < 0.001). Of significance, individuals with T2DM using glucagon-like peptide-1 receptor agonists (GLP-1a) and sodium-glucose co-transporter 2 inhibitors (SGLT-2i) manifested significantly lower LSM (-20.55% and -25.17%, respectively), while insulin use was associated with a 101.38% higher LSM compared to non-insulin users.

Conclusions: MAFLD exhibits a notably high prevalence in this cohort, with T2DM leading to a higher LSM. Individuals with MAFLD frequently have concurrent CKD and IHD. The observed LSM reduction among individuals using SGLT-2i or GLP-1a underscores the potential utility of clinical trials to assess their efficacy in attenuating MAFLD progression.

J Endocrinol Metab. 2024;14(2):63-70
doi: https://doi.org/10.14740/jem937


MAFLD; Type 2 diabetes mellitus; Antiglycemic therapy; Liver fibrosis

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