Factors Associated With Advanced Liver Fibrosis in a Population With Type 2 Diabetes: A Multicentric Study in Mexico City

Abstract

Background and objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease, primarily due to insulin resistance and type 2 diabetes (T2D). Despite the strong link between T2D and MASLD, identifying and treating liver fibrosis in T2D patients is still poor. This study aimed to identify the factors related to advanced liver fibrosis in T2D patients.

Methods

This retrospective observational study used medical records from four centers in Mexico City from 2018 to 2023. The study included 2000 patients with T2D. Liver fibrosis was evaluated using the Fibrosis-4 (FIB-4) index, and insulin resistance was assessed using the estimated glucose disposal rate (eGDR).

Results

The mean age of the patients was 58.9 years, with 63.7% being women. The median duration of T2D was 7 years, and the mean HbA1c was 7.63%. Overall, 20.4% had advanced liver fibrosis. The multivariate logistic regression analysis showed that diabetes duration >10 years {odds ratio (OR) = 2.105 (95% confidence interval [CI] 1.321–3.355)}, fasting glucose >126 mg/dL (OR = 1.568 [95% CI 1.085–2.265]), and microalbuminuria >300 mg/24 h (OR = 2.007 [95% CI 1.134–3.552]) were associated with advanced liver fibrosis. Conversely, the eGDR (OR = 0.805 [95% CI 0.703–0.888]), statins (OR = 0.111 [95% CI 0.073–0.168]), and pioglitazone (OR = 0.082 [95% CI 0.010–0.672]) were inversely associated.

Conclusion

Longer diabetes duration, insulin resistance, and microalbuminuria are independently linked to advanced liver fibrosis in T2D patients. Statins and pioglitazone may protect against liver fibrosis. Enhanced screening and management strategies targeting these factors could slow fibrosis progression and reduce the global burden of MASLD.