Prevalence of abnormal liver function and response to lifestyle interventions in newly diagnosed type 2 diabetes: preliminary results of a UK randomised controlled study

Abstract

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is increasingly common with prevalence between 20-34% in Europe and the US. There is a close association between NAFLD and features of the metabolic syndrome such as insulin resistance, hypertension and obesity. Aim: To examine liver health and the effect of lifestyle interventions in newly diagnosed type 2 diabetics. Method: Patients within 5-8 months of diagnosis of diabetes were identified from four centres in the South West of England. All participants received usual care for diabetes. Patients were randomised to usual care alone (UC), additional dietary advice (D) or additional dietary and exercise advice (D&E). LFTs were measured at baseline and twelve months. Results: Median age of participants was 61 years, 36% were female. Alcohol intake was modest and did not differ significantly between groups. Modest reductions in BMI and insulin resistance were seen in groups D and D&E: these were not significant. There was no change in blood pressure. At baseline 24 of 424 patients (5.6%) had any abnormality in liver function. At twelve months this was 15 of 212 patients (7.1%). Increased prevalence was seen in all groups except D. Transaminase levels followed the same trend with prevalence at baseline of 2.6% and 3.7% at 12 months. AST:ALT ratio (AAR) increased over twelve months with Pearson correlation of 0.92. In patients with raised transaminases, non-invasive assessment of fibrosis (NAFLD fibrosis score) demonstrated 20% of patients at risk of advanced fibrosis at baseline, climbing to 80% at twelve months, without differences between groups. This is 0.5% and 3% of all participants at baseline and twelve months respectively. Conclusion: In newly diagnosed diabetes abnormalities of liver function persist in the first year of diagnosis regardless of lifestyle intervention. Estimation of fibrosis in a subgroup of patients demonstrated increased prevalence of advanced fibrosis over twelve months. This is consistent with rising AAR over the same period for the whole group. Longer-term follow up of these patients is required, but initial data are similar to cohorts described elsewhere, and reflect a significant risk of liver disease in patients with Type 2 Diabetes.