Liver Fibrosis is Independently Associated with Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus.

Aims Non-alcoholic fatty liver disease and type 2 diabetes mellitus are closely related and often occur simultaneously in patients. Type 2 diabetes increases the risk of diabetic peripheral neuropathy, resulting in intolerable pain and extremity amputation that reduces the quality of life. However, the role of non-alcoholic fatty liver disease in the pathogenesis of diabetic peripheral neuropathy remains unclear. Thus, we evaluated the correlation of liver fibrosis and steatosis, which are representative histological morphologies of non-alcoholic fatty liver disease, with diabetic peripheral neuropathy in type 2 diabetes patients. Results Among the 520 patients, the prevalence of liver steatosis and fibrosis and diabetic peripheral neuropathy were 63.0% (n=328), 18.1% (n=94), and 52.1% (n=271), respectively. The prevalence of diabetic peripheral neuropathy was significantly elevated in patients with liver steatosis (55.7% vs. 44.9%, p=0.03) and fibrosis (61.5% vs. 50%, p=0.04), and it increased as liver stiffness measurement increased. Additionally, both hepatic steatosis (OR=1.48 [1.04-2.11], p=0.03) and fibrosis (OR=1.60 [1.02-2.51], p=0.04) were correlated with diabetic peripheral neuropathy. After adjusting for age, sex, weight, height, BMI, waist hip ratio, duration of T2DM, blood glucose, HOMA-IR, blood pressure, serum lipid, liver enzyme, urea, uric acid, creatinine, and inflammatory factors, liver fibrosis remained associated with diabetic peripheral neuropathy (OR=2.24 [1.11-4.53], p=0.02). Conclusion The prevalence of diabetic peripheral neuropathy was elevated in patients with liver steatosis and fibrosis. Liver fibrosis was also independently associated with an increased risk of diabetic peripheral neuropathy.