High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among U.S. Adults With Type 2 Diabetes Diabetes Care 2021;44:519–525 | https://doi.org/10.2337/dc20-1778 OBJECTIVE Type 2 diabetes mellitus (T2DM) is an important risk factor for the progression of metabolic liver disease to advanced fibrosis. Here, we provide an estimate of the prevalence of steatosis and fibrosis in U.S. adults with T2DM on the basis of transient elastography (TE) and identify factors associated with these conditions. RESEARCH DESIGN AND METHODS This is a cross-sectional study of U.S. adults with T2DM participating in the 2017– 2018 cycle of the National Health and Nutrition Examination Survey who were evaluated by TE. Hepatic steatosis and fibrosis were diagnosed by the median value of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. RESULTS Among the 825 patients with reliable TE examination results, 484 (53.7%) were assessed using the M probe and 341 (46.3%) using the XL probe. Liver steatosis (CAP ‡274 dB/m), advanced fibrosis (LSM ‡9.7 kPa), and cirrhosis (LSM ‡13.6 kPa) were present in 73.8% (95% CI 68.5%–78.5%), 15.4% (95% CI 12.2%–19.0%), and 7.7% (95% CI 4.8%–11.9%) of patients, respectively. The mean 6 SE age of patients with advanced fibrosis and cirrhosis was 63.7 6 2.2 years and 57.8 6 1.6 years, respectively. In the multivariable logistic regression model, BMI, non-Black race, and ALT levels were independent predictors of steatosis; and BMI, non-Black race, and AST and g-glutamyltranspeptidase levels were independent predictors of advanced fibrosis. CONCLUSIONS Prevalence of both liver steatosis and fibrosis is high in patients with T2DM from the United States and obesity is a major risk factor. Our results support the screening of these conditions among patients with diabetes. Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disorder worldwide (1), is associated with a substantial economic and clinical burden (2), and is the most rapidly growing indication for liver transplant, ranking second in the United States (3). NAFLD is tightly connected with obesity, ectopic fat deposition and insulin resistance (4); thus, its prevalence is particularly high in individuals at high metabolic risk, such as patients with type 2 diabetes mellitus (T2DM) (5), who are also at higher risk of progression toward nonalcoholic steatohepatitis, advanced fibrosis, and cirrhosis. 1 Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy 2 Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy 3 Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy Corresponding author: Gianluca Perseghin, gian- luca.perseghin@policlinicodimonza.it Received 15 July 2020 and accepted 1 November 2020 This article contains supplementary material online at https://doi.org/10.2337/figshare.13222142. © 2020 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More infor- mation is available at https://www.diabetesjournals .org/content/license. Stefano Ciardullo, 1,2 Tommaso Monti, 3 and Gianluca Perseghin 1,2 Diabetes Care Volume 44, February 2021 519 PATHOPHYSIOLOGY/COMPLICATIONS Downloaded from http://diabetesjournals.org/care/article-pdf/44/2/519/532034/dc201778.pdf by guest on 21 April 2023