Predicting the risk of developing diabetes in steatotic liver disease using controlled attenuation parameter in a health checkup population.

Introduction: Excessive hepatic steatosis is linked to systemic metabolic disorders. We investigated the association between hepatic steatosis quantified by controlled attenuation parameter (CAP) and the development of type 2 diabetes mellitus (T2DM) in a health checkup population.

Methods: The present retrospective cohort study included 1636 participants without T2DM who underwent CAP measurement and were followed up at annual health checkups. Cox proportional hazards regression was used to identify risk factors for T2DM development.

Results: During a mean follow-up of 3.2 years, 181 participants developed T2DM. The cumulative incidence rates of T2DM were significantly higher in participants with severe steatosis (CAP ≥ 280 dB/m) compared with those without (13.9% vs. 4.8% at 3 years, p < 0.001). Multivariate analysis identified CAP as an independent predictor of new-onset T2DM (adjusted hazard ratio [aHR], 1.04 per 10 dB/m increase; 95% confidence interval [CI], 1.01-1.08, p = 0.01), along with fasting plasma glucose (aHR, 2.13 per 10 mg/dL; 95% CI, 1.77-2.55, p < 0.001), HbA1c (aHR, 1.25 per 0.1% increase; 95% CI, 1.19-1.32, p < 0.001), and platelet count (aHR, 0.95 per 10⁴/μL increase; 95% CI, 0.92-0.98, p = 0.001). A dose-response relationship was observed between CAP level and T2DM risk. In addition, suspected compensated advanced chronic liver disease (liver stiffness ≥10 kPa) and at-risk steatohepatitis (FibroScan-AST score ≥0.67) were associated with a higher incidence of T2DM (p < 0.001 for both).

Conclusion: CAP quantification of hepatic steatosis effectively stratifies the risk of developing T2DM, facilitating timely intervention and prevention strategies.