Type 2 diabetes mellitus (T2DM) is associated with risk for non-alcoholic fatty liver disease (NAFLD) and considered a major risk factor for clinically significant liver disease. Therefore, routine screening for NAFLD in this population has been recommended. Because screening would be resource-intensive, identifying those at highest risk would assist in targeting screening initiatives.
Using data from the Swedish National Diabetes Register, researchers compared the incidence of severe liver disease (defined as development of cirrhosis or hepatocellular carcinoma [HCC], liver failure, or liver-related death) in over 400,000 individuals with T2DM and over 2 million individuals without T2DM, matched on age, sex, and county of residence (controls). They also assessed risk factors for severe liver disease in the T2DM group.
During a median follow-up of 7.7 years, 1.3% of patients with T2DM and 0.6% of controls developed severe liver disease (hazard ratio, 2.3; P<0.001). HCC rates were also significantly higher in individuals with T2DM versus controls (0.26% vs. 0.08%), as were liver-related death rates (0.49% vs. 0.22%).
Among those with T2DM, independent predictors of severe liver disease included male sex, older age, higher body-mass index, hypertension, and renal abnormalities (lower glomerular filtration rate and microalbuminuria), whereas statin use was a protective factor.