Evaluation of the reciprocal interaction between hepatic steatosis and type 2 diabetes: a comparative analysis with respect to anti-diabetic treatment, glycemic control, renal and hepatic function (original) (raw)

Abstract

Background

This study aimed to evaluate reciprocal interaction between hepatic steatosis (HS) and type 2 diabetes (T2D) through comparative analysis of anti-diabetic treatment, glycemic control, and renal and hepatic function in T2D patients with versus without concomitant HS.

Methods

A total of 102 T2D patients were included in this cross-sectional single-center study, and patients were divided into two groups including those with HS (n = 58) and those without HS (n = 44). Data on patient demographics, current anti-diabetic treatment, and serum levels for fasting blood glucose (FBG), HbA1c (%), urea, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lipids were recorded.

Results

Diabetic patients with HS had younger age (59.6 ± 10.5 vs. 63.5 ± 14.5 years, p = 0.034) and lower serum urea levels (28.5 (3–61) vs. 39 (14–138), p = 0.012). Metformin (74.1% in patients with HS, 65.9% in patients without HS) was the most frequent anti-diabetic treatment in both groups with similar rate of glycemic control (HbA1c < 7%, 39.7%, and 40.9% of patients, respectively). HbA1c levels were positively correlated with serum urea (r = 0.308, p = 0.042), creatinine (r = 0.306, p = 0.044), and triglyceride (r = 0.358, p = 0.017) levels only in patients without HS. In patients with HS, no significant difference was noted in ALT and AST levels with respect to anti-diabetic regimen. Logistic regression analysis revealed that the presence of proteinuria (OR, 0.327, 95% CI 0.12 to 0.91, p = 0.032) was associated with decreased likelihood of HS in T2D patients.

Conclusion

In conclusion, our findings revealed no increase in the risk of poor glycemic control, dyslipidemia, or nephropathy pertaining to concomitant HS in T2D patients, as well as no difference in ongoing anti-diabetic treatments in terms of serum ALT and AST levels.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Availability of data and material

Raw data can be obtained upon request to the corresponding author (teslime.ayaz@erdogan.edu.tr).

References

  1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.
    Article CAS Google Scholar
  2. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43(2 Suppl. 1):S99–112.
    Article CAS Google Scholar
  3. Clark JM, Diehl AM. Hepatic steatosis and type 2 diabetes mellitus. Curr Diab Rep. 2002;2:210–5.
    Article Google Scholar
  4. Mills EP, Brown KPD, Smith JD, Vang PW, Trotta K. Treating nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a review of efficacy and safety. Ther Adv Endocrinol Metab. 2018;9:15–28.
    Article CAS Google Scholar
  5. Rhee EJ. Nonalcoholic fatty liver disease and diabetes: an epidemiological perspective. Endocrinol Metab (Seoul). 2019;34:226–33.
    Article CAS Google Scholar
  6. Lonardo A, Nascimbeni F, Mantovani A, Targher G. Hypertension, diabetes, atherosclerosis and NASH: cause or consequence? J Hepatol. 2018;68:335–52.
    Article Google Scholar
  7. Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016;65:1038–48.
    Article CAS Google Scholar
  8. Targher G, Bertolini L, Rodella S, Zoppini G, Lippi G, Day C, et al. Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients. Diabetologia. 2008;51:444–50.
    Article CAS Google Scholar
  9. Targher G, Chonchol M, Bertolini L, Rodella S, Zenari L, Lippi G, et al. Increased risk of CKD among type 2 diabetics with nonalcoholic fatty liver disease. J Am Soc Nephrol. 2008;19:1564–70.
    Article CAS Google Scholar
  10. Targher G, Bertolini L, Rodella S, Tessari R, Zenari L, Lippi G, et al. Nonalcoholic fatty liver disease is independently NAFLD and diabetes mellitus associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care. 2007;30:2119–21.
    Article CAS Google Scholar
  11. Dawwas GK, Liu X, Nguyen MH. Nonalcoholic fatty liver disease increases risk of incident advanced chronic kidney disease: a propensity-matched cohort study. J Intern Med. 2019;286:711–22.
    Article Google Scholar
  12. Wu S, Wu F, Ding Y, Hou J, Bi J, Zhang Z. Association of non-alcoholic fatty liver disease with major adverse cardiovascular events: a systematic review and meta-analysis. Sci Rep. 2016;6:33386.
    Article CAS Google Scholar
  13. Chinnadurai R, Ritchie J, Green D, Kalra PA. Nonalcoholic fatty liver disease and clinical outcomes in chronic kidney disease. Nephrol Dial Transplant. 2019;34:449–57.
    Article CAS Google Scholar
  14. Capone D, Vinciguerra M, Ragosta A, Citro V, Tarantino G. Troponin levels relate to CRP concentrations in patients with NAFLD on maintenance haemodialysis: a retrospective study. Adv Ther. 2020;37:3337–47.
    Article CAS Google Scholar
  15. Kang SH, Cho KH, Do JY. Non-alcoholic fatty liver disease is associated with low-grade albuminuria in men without diabetes mellitus. Int J Med Sci. 2019;16:285–91.
    Article CAS Google Scholar
  16. Chutani A, Pande S. Correlation of serum creatinine and urea with glycemic index and duration of diabetes in type 1 and type 2 diabetes mellitus: a comparative study. Nat J Physiol Pharm Pharmacol. 2017;7:914–9.
    CAS Google Scholar
  17. Karningsih TP, Mujianto B, Martini R. The Correlation between the levels of HbA1c with ureum and creatinine in patient with type 2 diabetes mellitus. Asian J Applied Sci. 2019;7:696–700.
    Google Scholar
  18. Vaishnavi S, Patil S, Sontakke A, Mane D. Study of correlation between HbA1c and renal dysfunction in type-2 diabetes mellitus. Indian J Public Health Res Development. 2019;10:194–9.
    Article Google Scholar
  19. Sivasubramanian V, Jetty K, Kumar SS. Correlation of HbA1c with urinary ACR, serum creatinine and eGFR in type-2 diabetes mellitus at Puducherry, South India. Int J Res Med Sci. 2019;7:1924–8.
    Article Google Scholar
  20. Farasat T, Sharif S, Naz S, Fazal S. Significant association of serum creatinine with HbA1C in impaired glucose tolerant Pakistani subjects. Pak J Med Sci. 2015;31:991–4.
    PubMed PubMed Central Google Scholar
  21. Mantovani A, Byrne CD, Bonora E, Targher G. Nonalcoholic fatty liver disease and risk of incident type 2 diabetes: a meta-analysis. Diabetes Care. 2018;41:372–82.
    Article CAS Google Scholar
  22. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015;62:S47-64.
    Article Google Scholar
  23. Dewidar B, Kahl S, Pafili K, Roden M. Metabolic liver disease in diabetes - from mechanisms to clinical trials. Metabolism. 2020;111S:154299.
  24. Zhang M, Lin S, Wang MF, Huang JF, Liu SY, Wu SM, et al. Association between NAFLD and risk of prevalent chronic kidney disease: why there is a difference between east and west? BMC Gastroenterol. 2020;20:139.
    Article CAS Google Scholar
  25. Stepanova M, Rafiq N, Younossi ZM. Components of metabolic syndrome are independent predictors of mortality in patients with chronic liver disease: a population-based study. Gut. 2010;59:1410–5.
    Article Google Scholar
  26. Zaharia OP, Strassburger K, Strom A, Bönhof GJ, Karusheva Y, Antoniou S, et al. Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study. Lancet Diabetes Endocrinol. 2019;7:684–94.
    Article Google Scholar
  27. Ahlqvist E, Storm P, Käräjämäki A, Martinell M, Dorkhan M, Carlsson A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a datadriven cluster analysis of six variables. Lancet Diabetes Endocrinol. 2018;6:361–9.
    Article Google Scholar
  28. Nampoothiri RV, Duseja A, Rathi M, Agrawal S, Sachdeva N, Mehta M, et al. Renal dysfunction in patients with nonalcoholic fatty liver disease is related to the presence of diabetes mellitus and severity of liver disease. J Clin Exp Hepatol. 2019;9:22–8.
    Article Google Scholar
  29. Musso G, Gambino R, Tabibian JH, Ekstedt M, Kechagias S, Hamaguchi M, et al. Association of nonalcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med. 2014;11:e1001680.
  30. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the study of liver diseases, American College of Gastroenterology, and the American Gastroenterological Association. Am J Gastroenterol. 2012;107:811–26.
    Article Google Scholar
  31. Bhatt HB, Smith RJ. Fatty liver disease in diabetes mellitus. HepatoBiliary Surg Nutr. 2015;4:101–8.
    PubMed PubMed Central Google Scholar
  32. Li Y, Liu L, Wang B, Wang J, Chen D. Metformin in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Biomed Rep. 2013;1:57–64.
    Article CAS Google Scholar

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
    Teslime Ayaz, Hatice Beyazal Polat & Bilgesah Kilictas

Authors

  1. Teslime Ayaz
  2. Hatice Beyazal Polat
  3. Bilgesah Kilictas

Corresponding author

Correspondence toTeslime Ayaz.

Ethics declarations

Ethics approval

The study was conducted in accordance with the ethical principles stated in the “Declaration of Helsinki” and approved by the institutional ethics committee.

Written informed consent was obtained from each patient following a detailed explanation of the objectives and protocol of the study which was conducted in accordance with the ethical principles stated in the “Declaration of Helsinki” and approved by the institutional ethics committee.

The permission was obtained from the institutional ethics committee for the use of patient data for publication purposes.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

About this article

Cite this article

Ayaz, T., Polat, H.B. & Kilictas, B. Evaluation of the reciprocal interaction between hepatic steatosis and type 2 diabetes: a comparative analysis with respect to anti-diabetic treatment, glycemic control, renal and hepatic function.Int J Diabetes Dev Ctries 42, 421–427 (2022). https://doi.org/10.1007/s13410-021-01009-4

Download citation

Keywords