Endocrine Abstracts

JOINT420

Background: Metabolic-associated steatotic liver disease (MASLD) is increasingly recognized as a severe comorbidity in patients with Type 2 diabetes Mellitus (T2DM). Despite the known overlap between these conditions, the specific diabetes-related factors that drive the progression to advanced liver fibrosis in MASLD remain poorly understood. This study aims to investigate the associations between T2DM factors and the risk of advanced fibrosis in T2DM patients with MASLD.

Methods: This was a retrospective, descriptive and analytical study of T2DM patients with MASLD, followed at the Endocrinology-Diabetology Department of Hedi Chaker University Hospital in Sfax, Tunisia. We used the fibrosis-4 index (FIB-4) and the NAFLD fibrosis score (NFS) to evaluate the risk of advanced fibrosis among the patients. High risk of advanced fibrosis is indicated by a FIB-4 score >2.67 and an NFS score >0.675. The patients were categorized then into two groups: a high-risk group for advanced fibrosis and an intermediate and low-risk group.

Results: This study included 101 T2DM patients with MASLD. Neither the age at diagnosis of T2DM nor its duration were significantly associated with advanced fibrosis (P>0.05), regardless of the score used. However, blood glucose levels (12.0 mmol/l [7.2-14.6], 8.0 mmol/l [6.0-12.0], P = 0.024) and HbA1c levels (9.7% [6.9-12.0], 7.2% [6.6-9.8], P = 0.038) were significantly lower in the high-risk fibrosis group, according to NFS score. The use of anti-diabetic medications did not seem to be associated with the progression to advanced fibrosis when predicted by the FIB-4 score. However, when the NFS score was used, insulin therapy was more frequently associated with the high-risk fibrosis group (P = 0.007), while sulfonylureas were more prescribed in the low- and intermediate-risk group (P = 0.004). Renal function was significantly more impaired in the high-risk fibrosis group according to both NFS (P = 0.001) FIB-4 (P = 0.044) scores, and erectile dysfunction was significantly associated with the progression to fibrosis when predicted by NFS score (P = 0.039). When NFS score was used, individuals at high risk of fibrosis exhibited significantly higher rates of microangiopathies (P = 0.046) and ischemic heart disease (P = 0.037) compared to those with low or intermediate risk. These significant differences disappeared when subgroups were based on the FIB-4 score.

Conclusion: Understanding how these diabetes-related factors interact with MASLD to accelerate fibrosis progression is crucial for improving patient outcomes.