Metabolic dysfunction-associated steatotic liver disease, insulin sensitivity and continuous glucose monitoring metrics in patients with type 1 diabetes: A multi-centre cross-sectional study

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes, Obesity & Metabolism Pub Date : 2025-03-13 DOI:10.1111/dom.16333

Michela Vergani MD, Nicolò Diego Borella MD, Mariangela Rizzo MD, Matteo Conti MD, Silvia Perra MD, Eleonora Bianconi MD, Elena Sani MD, Alessandro Csermely MD, Elisabetta Grespan MD, Giovanni Targher MD, Gianluca Perseghin MD, Alessandro Mantovani MD, Stefano Ciardullo MD

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Abstract

Background and aim

We assessed the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and significant liver fibrosis in adults with type 1 diabetes mellitus (T1DM) and the association of MASLD with insulin sensitivity and continuous glucose monitoring metrics.

Methods

We consecutively enrolled 198 adults with T1DM undergoing vibration-controlled transient elastography with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). All participants had a continuous glucose monitoring (CGM) device. Insulin sensitivity was evaluated by estimated glucose disposal rate (eGDR). MASLD was defined as CAP ≥ 248 db/m and the presence of at least one cardiometabolic risk factor. Significant liver fibrosis was defined as LSM ≥ 7 kPa.

Results

Patients had a mean age of 56 years, mean BMI of 26.0 ± 5.9 kg/m², and mean eGDR of 7.1 ± 2.3 mg/kg/min. 73 (37%) patients had MASLD (using a CAP threshold of 274 dB/m), 16 (8.1%) of whom had significant liver fibrosis. MASLD was associated with a significantly lower eGDR (beta coefficient = −0.367, 95% confidence interval −0.472 to −0.261; p < 0.001). This association remained significant, even after adjustment for age, sex, body mass index, plasma triglycerides, diabetes duration, daily insulin dose, time above the range of glucose levels, LSM and chronic kidney disease. No association was observed between MASLD and CGM-derived metrics. These results were not different when we used a CAP threshold of 274 dB/m for diagnosing MASLD.

Conclusion

In T1DM, MASLD was inversely associated with eGDR and biomarkers of insulin resistance but not with CGM-derived metrics.

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1型糖尿病患者代谢功能障碍相关的脂肪变性肝病、胰岛素敏感性和连续血糖监测指标：一项多中心横断面研究

背景和目的：我们评估了1型糖尿病（T1DM）成人代谢功能障碍相关性脂肪性肝病（MASLD）和明显肝纤维化的患病率，以及MASLD与胰岛素敏感性和连续血糖监测指标的关联：我们连续招募了198名患有T1DM的成人，对他们进行了振动控制瞬态弹性成像，并测量了肝脏硬度（LSM）和受控衰减参数（CAP）。所有参与者均配有连续血糖监测（CGM）装置。胰岛素敏感性通过估计葡萄糖排出率（eGDR）进行评估。MASLD的定义是CAP≥248 db/m，且至少存在一个心脏代谢风险因素。显著肝纤维化的定义是 LSM ≥ 7 kPa：患者的平均年龄为 56 岁，平均体重指数（BMI）为 26.0 ± 5.9 kg/m2，平均 eGDR 为 7.1 ± 2.3 mg/kg/min。73名（37%）患者患有MASLD（CAP阈值为274 dB/m），其中16名（8.1%）患者有明显的肝纤维化。MASLD 与较低的 eGDR 显著相关（β 系数 = -0.367，95% 置信区间 -0.472 至 -0.261；P 结论：MASLD 与 eGDR 的相关性较低：在 T1DM 患者中，MASLD 与 eGDR 和胰岛素抵抗的生物标志物成反比，但与 CGM 派生指标无关。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.