Endocrine Abstracts

JOINT418

Background: The progression of advanced fibrosis in type 2 diabetes mellitus (T2DM) patients with metabolic associated steatotic liver disease (MASLD) is shaped by a complex interplay of cardio-metabolic risk factors, many of which remain poorly understood. Identifying the specific cardio-metabolic factors driving this progression could unlock new opportunities for early intervention and personalized treatment strategies. This study aims to uncover the key cardio-metabolic risk factors that promote advanced fibrosis in diabetic patients with MASLD.

Methods: This retrospective and comparative study included T2DM patients with confirmed MASLD, followed from 2012 to 2024 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 exceeding 2.67 and an NFS score exceeding 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 presence of metabolic syndrome nor its individual components (waist circumference, dyslipidemia, systolic blood pressure, diastolic blood pressure) were significantly associated with the risk of fibrosis in our cohort (FIB-4: P = 0,068; NFS: P=0,232). The most notable association was with hypertension, which was significantly linked to fibrotic liver lesions based on the NFS score (P=0,033). Regardless of the fibrosis score used, spironolactone prescriptions were significantly more frequent in patients at high risk of advanced fibrosis (FIB-4: P = 0.031; NFS: P = 0.006). Other antihypertensive treatments (renin-angiotensin system blockers, calcium channel blockers, thiazide diuretics, and beta-blockers), as well as their adherence, had no significant impact on the progression to advanced fibrosis. Additionally, no substantial effect on advanced fibrosis was observed from any dyslipidemia parameters or lipid fractions in the included patients.

Conclusion: This study aims to shed light on key cardio metabolic risk factors contributing to fibrosis progression, ultimately informing targeted interventions.