J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Original Article

Volume 14, Number 2, April 2024, pages 63-70

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

**Table 1.** Summary Statistics of General Patient Variables for MAFLD Patients
Characteristic	MAFLD (N = 437)	Non-MAFLD (N = 692)
^aDefined by BMI in kg/m². Underweight: < 18.5; normal 18.5 - 24.9; overweight: 25 - 29.9; class 1: 30 - 34.9; class 2: 35 - 39.9; class 3: > 40. For Asians class 1: 27.5 - 30. Mean (SD) is reported for age and BMI; median (IQR) is reported for LSM; counts and corresponding percentages are reported for categorical variables. BMI: body mass index; CKD: chronic kidney disease; IHD: ischemic heart disease; IQR: interquartile range; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease; SD: standard deviation; T2DM: type 2 diabetes mellitus.
Age (years)	58 (13)
Sex
Female	212 (49%)	391 (57%)
Male	225 (51%)	301 (43%)
Ethnicity
Asian	19 (4.3%)
Caucasian	413 (95%)
Other	5 (1.1%)
BMI (kg/m²)	34 (7)
Unknown	3
Obesity class^a
Normal BMI	16 (3.7%)
Overweight	100 (23%)
1	143 (33%)
2	100 (23%)
3	75 (17%)
Unknown	3
Hypertension
Yes	237 (54%)
No	200 (46%)
Dyslipidemia
Yes	266 (61%)
No	171 (39%)
IHD
Yes	84 (19%)	71 (10%)
No	350 (81%)	621 (90%)
Unknown	3
CKD
Yes	176 (40%)	115 (17%)
No	261 (60%)	577 (83%)
LSM (kPa)	7 (5, 10)
T2DM
Yes	223 (51%)	123 (18%)
No	214 (49%)	569 (82%)

Table 1. Summary Statistics of General Patient Variables for MAFLD Patients

Characteristic

MAFLD (N = 437)

Non-MAFLD (N = 692)

^aDefined by BMI in kg/m². Underweight: < 18.5; normal 18.5 - 24.9; overweight: 25 - 29.9; class 1: 30 - 34.9; class 2: 35 - 39.9; class 3: > 40. For Asians class 1: 27.5 - 30. Mean (SD) is reported for age and BMI; median (IQR) is reported for LSM; counts and corresponding percentages are reported for categorical variables. BMI: body mass index; CKD: chronic kidney disease; IHD: ischemic heart disease; IQR: interquartile range; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease; SD: standard deviation; T2DM: type 2 diabetes mellitus.

Age (years)

58 (13)

Sex

Female

212 (49%)

391 (57%)

Male

225 (51%)

301 (43%)

Ethnicity

Asian

19 (4.3%)

Caucasian

413 (95%)

Other

5 (1.1%)

BMI (kg/m²)

34 (7)

Unknown

Obesity class^a

Normal BMI

16 (3.7%)

Overweight

100 (23%)

143 (33%)

100 (23%)

75 (17%)

Unknown

Hypertension

Yes

237 (54%)

200 (46%)

Dyslipidemia

Yes

266 (61%)

171 (39%)

IHD

Yes

84 (19%)

71 (10%)

350 (81%)

621 (90%)

Unknown

CKD

Yes

176 (40%)

115 (17%)

261 (60%)

577 (83%)

LSM (kPa)

7 (5, 10)

T2DM

Yes

223 (51%)

123 (18%)

214 (49%)

569 (82%)

**Table 2.** Summary Statistics of T2DM-Specific Patient Variables for MAFLD Patients With T2DM
Characteristic	N = 223
Mean (SD) is reported for HbA1c; counts and corresponding percentages are reported for categorical variables. DPP4i: dipeptidyl peptidase-4 inhibitors; GLP-1a: glucagon-like peptide-1 receptor agonists; HbA1c: hemoglobin A1c; MAFLD: metabolic dysfunction-associated fatty liver disease; SGLT-2i: sodium-glucose co-transporter 2 inhibitors; T2DM: type 2 diabetes mellitus.
HbA1c	7.35 (1.70)
Unknown	8
Metformin
Yes	187 (84%)
No	36% (16%)
Sulfonylurea
Yes	53 (24%)
No	170 (76%)
DPP4i
Yes	42 (19%)
No	181 (81%)
GLP-1a
Yes	62 (28%)
No	161 (72%)
SGLT-2i
Yes	69% (31%)
No	153 (69%)
Unknown	1
Insulin
Yes	49 (22%)
No	173 (78%)
Unknown	1

Table 2. Summary Statistics of T2DM-Specific Patient Variables for MAFLD Patients With T2DM

Characteristic

N = 223

Mean (SD) is reported for HbA1c; counts and corresponding percentages are reported for categorical variables. DPP4i: dipeptidyl peptidase-4 inhibitors; GLP-1a: glucagon-like peptide-1 receptor agonists; HbA1c: hemoglobin A1c; MAFLD: metabolic dysfunction-associated fatty liver disease; SGLT-2i: sodium-glucose co-transporter 2 inhibitors; T2DM: type 2 diabetes mellitus.

HbA1c

7.35 (1.70)

Unknown

Metformin

Yes

187 (84%)

36% (16%)

Sulfonylurea

Yes

53 (24%)

170 (76%)

DPP4i

Yes

42 (19%)

181 (81%)

GLP-1a

Yes

62 (28%)

161 (72%)

SGLT-2i

Yes

69% (31%)

153 (69%)

Unknown

Insulin

Yes

49 (22%)

173 (78%)

Unknown

**Table 3.** Linear Regression Results for Testing the Effect of Patient Characteristics on Log-Transformed LSM in MAFLD Patients
Characteristic	Beta	95% CI	P-value
Coefficient estimates (beta) and the corresponding 95% CI and P-value for each predictor variable are reported. For each of the diabetic treatment predictors, the disuse of a treatment was taken as the baseline value for each predictor variable. CI: confidence interval; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease; T2DM: type 2 diabetes mellitus.
Age	0.007	0.002, 0.012	0.006
Sex
Female	-	-
Male	0.056	-0.060, 0.171	0.3
T2DM
No	-	-
Yes	0.270	0.148, 0.392	< 0.001
Obesity
Non-obese	-	-
Obese	0.218	-0.088, 0.524	0.2
Hypertension
No	-	-
Yes	-0.048	-0.179, 0.083	0.5
Dyslipidemia
No	-	-
Yes	0.015	-0.114, 0.144	0.8

Table 3. Linear Regression Results for Testing the Effect of Patient Characteristics on Log-Transformed LSM in MAFLD Patients

Characteristic

Beta

95% CI

P-value

Coefficient estimates (beta) and the corresponding 95% CI and P-value for each predictor variable are reported. For each of the diabetic treatment predictors, the disuse of a treatment was taken as the baseline value for each predictor variable. CI: confidence interval; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease; T2DM: type 2 diabetes mellitus.

Age

0.007

0.002, 0.012

0.006

Sex

Female

Male

0.056

-0.060, 0.171

0.3

T2DM

Yes

0.270

0.148, 0.392

< 0.001

Obesity

Non-obese

Obese

0.218

-0.088, 0.524

0.2

Hypertension

Yes

-0.048

-0.179, 0.083

0.5

Dyslipidemia

Yes

0.015

-0.114, 0.144

0.8

**Table 4.** Linear Regression Results for Testing the Effect of HbA1c and the Use of Diabetic Treatments on Log-Transformed LSM in MAFLD Patients With T2DM
Characteristic	Beta	95% CI	P-value
Coefficient estimates (beta) and the corresponding 95% confidence interval and P-value for each predictor variable is reported. For each of the diabetic treatment predictors, the disuse of a treatment was taken as the baseline value for each predictor variable. CI: confidence interval; DPP4i: dipeptidyl peptidase-4 inhibitors; GLP-1a: glucagon-like peptide-1 receptor agonists; HbA1c: hemoglobin A1c; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease; SGLT-2i: sodium-glucose co-transporter 2 inhibitors; T2DM: type 2 diabetes mellitus.
HbA1c	-0.02	-0.08, 0.03	0.4
Metformin	0.03	-0.20, 0.26	0.8
Sulfonylurea	0.07	-0.14, 0.28	0.5
DPP4i	0.09	-0.13, 0.30	0.4
GLP-1a	-0.23	-0.41, -0.05	0.013
SGLT-2i	-0.29	-0.47, 0.11	0.001
Insulin	0.70	0.50, 0.91	< 0.001

Table 4. Linear Regression Results for Testing the Effect of HbA1c and the Use of Diabetic Treatments on Log-Transformed LSM in MAFLD Patients With T2DM

Characteristic

Beta

95% CI

P-value

Coefficient estimates (beta) and the corresponding 95% confidence interval and P-value for each predictor variable is reported. For each of the diabetic treatment predictors, the disuse of a treatment was taken as the baseline value for each predictor variable. CI: confidence interval; DPP4i: dipeptidyl peptidase-4 inhibitors; GLP-1a: glucagon-like peptide-1 receptor agonists; HbA1c: hemoglobin A1c; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease; SGLT-2i: sodium-glucose co-transporter 2 inhibitors; T2DM: type 2 diabetes mellitus.

HbA1c

-0.02

-0.08, 0.03

0.4

Metformin

0.03

-0.20, 0.26

0.8

Sulfonylurea

0.07

-0.14, 0.28

0.5

DPP4i

0.09

-0.13, 0.30

0.4

GLP-1a

-0.23

-0.41, -0.05

0.013

SGLT-2i

-0.29

-0.47, 0.11

0.001

Insulin

0.70

0.50, 0.91

< 0.001

**Table 5.** Linear Regression Results for Testing the Effect of LSM, BMI, HbA1c % on MAFLD Patients’ Total Daily Insulin Dose
Characteristic	Beta	95% CI	P-value
BMI: body mass index; CI: confidence interval; HbA1c: hemoglobin A1c; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease.
LSM (kPa)	0.94	0.11, 1.8	0.028
BMI	0.12	-2.3, 2.6	> 0.9
HbA1c	9.7	1.9, 18	0.016

Table 5. Linear Regression Results for Testing the Effect of LSM, BMI, HbA1c % on MAFLD Patients’ Total Daily Insulin Dose

Characteristic

Beta

95% CI

P-value

BMI: body mass index; CI: confidence interval; HbA1c: hemoglobin A1c; LSM: liver stiffness measurement; MAFLD: metabolic dysfunction-associated fatty liver disease.

LSM (kPa)

0.94

0.11, 1.8

0.028

BMI

0.12

-2.3, 2.6

> 0.9

HbA1c

9.7

1.9, 18

0.016

**Table 6.** Logistic Regression Results for Testing the Effects of LSM on Odds of CKD
Characteristic	OR	95% CI	P-value
CI: confidence interval; CKD: chronic kidney disease; LSM: liver stiffness measurement; OR: odds ratio.
LSM (kPa)	1.05	1.02, 1.08	0.003

Table 6. Logistic Regression Results for Testing the Effects of LSM on Odds of CKD

Characteristic

95% CI

P-value

CI: confidence interval; CKD: chronic kidney disease; LSM: liver stiffness measurement; OR: odds ratio.

LSM (kPa)

1.05

1.02, 1.08

0.003

**Table 7.** Logistic Regression Results for Testing the Effects of LSM on Odds of IHD
Characteristic	OR	95% CI	P-value
CI: confidence interval; IHD: ischemic heart disease; LSM: liver stiffness measurement; OR: odds ratio.
LSM (kPa)	1.02	1.00, 1.03	0.079

Table 7. Logistic Regression Results for Testing the Effects of LSM on Odds of IHD

Characteristic

95% CI

P-value

CI: confidence interval; IHD: ischemic heart disease; LSM: liver stiffness measurement; OR: odds ratio.

LSM (kPa)

1.02

1.00, 1.03

0.079

**Table 8.** Proportions of CKD and IHD in Patients With T2DM and Non-T2DM
Characteristic	Diabetic (N = 223)	Non-diabetic (N = 214)	P-value*
Data are expressed as n (%). *Fisher’s exact test. CKD: chronic kidney disease; IHD: ischemic heart disease; T2DM: type 2 diabetes mellitus.
CKD			0.011
Yes	103 (46%)	73 (34%)
No	120 (54%)	141 (66%)
IHD
Yes	63 (28%)	21 (10.0%)	< 0.001
No	160 (72%)	190 (90%)
Unknown	0	3

Table 8. Proportions of CKD and IHD in Patients With T2DM and Non-T2DM

Characteristic

Diabetic (N = 223)

Non-diabetic (N = 214)

P-value*

Data are expressed as n (%). *Fisher’s exact test. CKD: chronic kidney disease; IHD: ischemic heart disease; T2DM: type 2 diabetes mellitus.

CKD

0.011

Yes

103 (46%)

73 (34%)

120 (54%)

141 (66%)

IHD

Yes

63 (28%)

21 (10.0%)

< 0.001

160 (72%)

190 (90%)

Unknown