Differing clinical phenotype for higher alanine-aminotransferase (ALT) compared with high-risk NAFLD fibrosis score in type 2 diabetes mellitus

Kathryn H Williams; Kharis Burns; Stephen M Twigg

doi:10.1016/j.jdiacomp.2017.12.010

Differing clinical phenotype for higher alanine-aminotransferase (ALT) compared with high-risk NAFLD fibrosis score in type 2 diabetes mellitus

J Diabetes Complications. 2018 Mar;32(3):321-324. doi: 10.1016/j.jdiacomp.2017.12.010. Epub 2017 Dec 29.

Authors

Kathryn H Williams¹, Kharis Burns², Stephen M Twigg³

Affiliations

¹ Nepean Clinical School, The University of Sydney, Kingswood, New South Wales 2747, Australia; Nepean Hospital, Kingswood, New South Wales 2747, Australia; Dept of Endocrinology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia; Greg Brown Diabetes and Endocrinology Research Laboratory, Charles Perkins Centre and Bosch Institute, Building D17, The University of Sydney, New South Wales 2006, Australia.
² Dept of Endocrinology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia; Westmead Hospital, Cnr Darcy Road and Bridge Street, Westmead, NSW 2145, Australia.
³ Dept of Endocrinology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia; Greg Brown Diabetes and Endocrinology Research Laboratory, Charles Perkins Centre and Bosch Institute, Building D17, The University of Sydney, New South Wales 2006, Australia. Electronic address: stephen.twigg@sydney.edu.au.

PMID: 29398327
DOI: 10.1016/j.jdiacomp.2017.12.010

Abstract

Aims: The impact of non-alcoholic fatty liver disease (NAFLD) presence and severity on the diabetes phenotype remains unclear. Our study aimed to explore and contrast the phenotypes associated with higher ALT and high-risk NAFLD fibrosis score (NFS) in type 2 diabetes.

Methods: 324 patients with type 2 diabetes mellitus who were seen at a diabetes centre for a complications assessment with data for NFS were available for study. Data regarding co-morbidities and pathology were obtained at assessment and by file audit. Logistic regression was used to determine if there were significant relationships between pre-determined diabetes complications and co-morbidities and ALT or high-risk NFS (>0.675).

Results: Significant univariate associations with lower ALT included those of osteoporosis/osteopenia and inability to sense the monofilament. High-risk NFS was associated with arrhythmia, VPT ≥ 25 V and albuminuria. The associations of high-risk NFS with albuminuria and VPT ≥ 25 V remained after adjustment.

Conclusions: In type 2 diabetes, the clinical phenotype of those with higher ALT is dissimilar, sometimes inverse, to those with high-risk NFS. More emphasis should be placed on liver fibrosis risk rather than on liver enzymes alone.

Keywords: Complications; Diabetes; NAFLD fibrosis score; Neuropathy; Non-alcoholic fatty liver disease (NAFLD).

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Alanine Transaminase / blood*
Cohort Studies
Diabetes Mellitus, Type 2 / complications*
Diabetes Mellitus, Type 2 / enzymology
Diabetes Mellitus, Type 2 / pathology
Female
Humans
Liver Cirrhosis / enzymology*
Liver Cirrhosis / etiology
Liver Cirrhosis / pathology*
Logistic Models
Male
Middle Aged
Non-alcoholic Fatty Liver Disease / enzymology*
Non-alcoholic Fatty Liver Disease / etiology
Non-alcoholic Fatty Liver Disease / pathology*

Substances

Alanine Transaminase