Diabetes mellitus and metabolic-associated fatty liver disease (MAFLD) are two of the two major health problems facing society today. With lifestyle changes, more and more people are suffering from these two diseases. Poor glycemic control in diabetic patients may lead to the development and progression of fatty liver, and MAFLD may exacerbate the condition of diabetes. More seriously, both diseases can trigger liver fibrosis, which is the early stage of cirrhosis and poses a serious threat to the patient's health. Therefore, early screening for liver fibrosis is essential for patients with diabetes mellitus and MAFLD. Through screening, signs of liver fibrosis can be detected in time, so that effective treatment measures can be taken to stop the further deterioration of the condition. This not only improves the patient's quality of life, but also reduces the risk of cirrhosis and liver cancer.
From June 21 to 24, 2024, the 84th Annual Meeting of the American Diabetes Association (ADA) was held in Orlando, the "City of a Thousand Lakes" in the United States. At the meeting, extensive attention was paid to diabetes and MAFLD, focusing on the joint screening and management of diabetes and MAFLD. Among them, French scholar Professor Cyrielle Caussy strongly recommended that patients with type 2 diabetes mellitus (T2DM) use noninvasive tests (NITs) to actively screen for advanced liver fibrosis caused by MASLD.
This multicenter, prospective study is designed to evaluate the diagnostic performance of the NITs-based screening pathway for advanced liver fibrosis recommended by the American Association for the Study of Liver Diseases (AASLD). A total of 568 patients with T2DM with MASLD from four French diabetes clinics were included between October 2020 and October 2023. Inclusion criteria also included age 40 to 80 years, BMI < 40 kg/m2, and detailed liver evaluation, including: Fibrotest, FibroMeter, FIB-4, NFS, ELF, and FibroScan-based transient elastography (TE). Risk stratification for advanced liver fibrosis was defined according to composite criteria.
The results showed that 71% of all participants had hypertension, 58% were males, the average age was 60.5 years, and the average BMI was 32.1 kg/m2. Overall, 19% of patients had intermediate to high risk of advanced liver fibrosis, of which 10% were at high risk.
The analysis showed that the AUROC of different NITs for the assessment of high-risk advanced liver fibrosis was NFS 0.70, FIB-4 0.79, Fibrometer 0.72, Fibrotest 0.77, and ELF 0.82. Among them, according to the screening pathway for advanced liver fibrosis in AASLD, 81.5% of patients were at low risk and 9.4% were false-negative (FN) as assessed using ELF; 18.5% of patients required specialist treatment for hepatology, and 9.4% had a false-positive (FP). With the TE screening pathway, 85.4% of patients were at low risk and 5.1% were FN. 14.6% required specialist treatment for hepatology and 1.2% had an FP (see Figure 1).
Figure 1. Screening roadmap for advanced liver fibrosis in AASLD
The results of this study suggest that the screening pathway recommended by AASLD for advanced liver fibrosis has good diagnostic performance in patients with T2DM and can identify advanced liver fibrosis. At the same time, the investigators indicated that TE-based screening for advanced liver fibrosis had a higher accuracy rate.
原文链接：Cyrielle Caussy, Bruno Vergès, Damien Leleu, et al. Comparison of Screening Pathways of Advanced Fibrosis Due to MASLD in Diabetology. ADA 2024 Abstract 81-OR
