medwireNews: Hepatic steatosis, measured by the fatty liver index (FLI), is associated with an increased risk for mortality and cardiovascular disease (CVD) among people with type 1 diabetes, suggests research presented at the 58th EASD Annual Meeting in Stockholm, Sweden.
These findings are in line with previous observations in the type 2 diabetes population, and indicate that “also in type 1 diabetes, calculation of fatty liver index may have prognostic value for detecting individuals at higher risk of death and cardiovascular events,” Giuseppe Penno (University of Pisa, Italy) told delegates.
The team evaluated rates of these outcomes among 774 people with type 1 diabetes (mean age 40 years, 53% men), of whom 11.6% had an FLI of 60 or higher, indicating hepatic steatosis, while 66.5% had an FLI below 30, indicating no hepatic steatosis, and the remaining 21.8% had an intermediate FLI.
Penno said that there was a “strong negative inverse correlation” between FLI and estimated glucose disposal rate at baseline, indicating an association between hepatic steatosis and insulin resistance.
During an average follow-up of 11.6 years, 7.4% of the cohort died. The highest mortality rate was seen in people with hepatic steatosis, at 22.2%, decreasing to 10.1% in the intermediate FLI group, and was lowest, at 3.9%, in those without hepatic steatosis.
Regression analysis demonstrated that people with hepatic steatosis had a significant 6.07-fold higher mortality risk than those without. This risk was attenuated to 2.51–3.04-fold, but remained statistically significant, in additional analyses adjusting for prior CVD and for CV risk factors and diabetes-related variables included in the Steno Type 1 Risk Engine and EURODIAB Risk Score models.
In accordance with these observations, the incidence of major CV events during the follow-up period was highest in people with hepatic steatosis and lowest in those without (17.2 vs 3.5%). The presence of hepatic steatosis was associated with a significant 5.41-fold increased risk for CV events, attenuated to a significant 2.25–2.98-fold in the adjusted analyses. The team observed a similar pattern of results for coronary events.
Together, these findings indicate that hepatic steatosis “is an independent predictor of all-cause mortality and incidence of major CV and coronary events” in the type 1 diabetes population, concluded Penno.
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