Blood glucose control and metabolic dysfunction-associated steatotic liver disease in people with type 1 diabetes

G Della Pepa; R Lupoli; M Masulli; R Boccia; R De Angelis; S Gianfrancesco; R Piccolo; C Rainone; A A Rivellese; G Annuzzi; L Bozzetto

doi:10.1007/s40618-024-02333-2

Blood glucose control and metabolic dysfunction-associated steatotic liver disease in people with type 1 diabetes

J Endocrinol Invest. 2024 Mar 18. doi: 10.1007/s40618-024-02333-2. Online ahead of print.

Authors

G Della Pepa^{1

2}, R Lupoli³, M Masulli¹, R Boccia¹, R De Angelis¹, S Gianfrancesco¹, R Piccolo¹, C Rainone¹, A A Rivellese¹, G Annuzzi⁴, L Bozzetto¹

Affiliations

¹ Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
² Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Via Giuseppe Moruzzi 1, 56100, Pisa, Italy.
³ Department of Molecular Medicine and Medical Biotechnology, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
⁴ Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy. annuzzi@unina.it.

PMID: 38498227
DOI: 10.1007/s40618-024-02333-2

Abstract

Purpose: Metabolic dysfunction-associated steatotic liver disease (MASLD) may have distinctive pathophysiological features in type 1 diabetes (T1D). We evaluated the independent role of blood glucose control on MASLD in T1D.

Methods: In a cross-sectional study on 659 T1D adult patients, MASLD was assessed by the Fatty Liver Index (FLI) and the Hepatic Steatosis Index (HSI). Anthropometric, biochemical, and clinical parameters were retrieved from electronic records. Blood glucose control status was evaluated by dividing participants into subgroups according to the median value of HbA1c [7.6% (60 mmol/mol)], and this analysis was repeated excluding overweight/obese patients.

Results: Patients with HbA1c above 7.6% (60 mmol/mol) showed significantly higher MASLD indices (HSI 38 ± 6 vs. 36 ± 5, p < 0.001; FLI 26 ± 26 vs.19 ± 19, p < 0.001), and higher proportions of MASLD identified by HSI (57 vs. 44%, p < 0.001) and FLI (14 vs. 7%, p < 0.001) than patients with HbA1c below 7.6% (60 mmol/mol). Similar results were obtained for HSI after the exclusion of overweight/obese patients. Stepwise linear regression analysis confirmed that HbA1c was independently associated with HSI (r = 0.496, p = 0.009) and FLI (r = 0.722, p = 0.007); waist circumference with HSI (r = 0.492, p < 0.001); and waist circumference (r = 0.700, p < 0.001), HDL cholesterol (r = 0.719, p < 0.001), and LDL cholesterol (r = 0.712, p < 0.001) with FLI.

Conclusions: Blood glucose control is a main factor associated with MASLD in adults with T1D, also independently of overweight and obesity. Appropriate therapeutic strategies focused on tight blood glucose control may also be needed for the prevention and treatment of MASLD in T1D.

Keywords: Fatty liver index; Glucose control; Hepatic steatosis index; Metabolic dysfunction-associated steatotic liver disease; Type 1 diabetes.