Glycogenic hepatopathy and non-alcoholic fatty liver disease in type 1 diabetes patients

Patients with type 1 diabetes mellitus (T1DM) sometimes have hepatomegaly and increased transaminase. This is usually due to non-alcoholic fatty liver disease (NAFLD) or, rarely, glycogenic hepatopathy (GH). A 13-year-old boy with NAFLD who was diagnosed with T1DM at 8 years of age, and a 13-year-old girl with GH who was found to have T1DM at 9 years of age were observed to have hepatomegaly and elevation of transaminase (aspartate aminotransferase [reference value, 12–30 IU/mL]/ alanine aminotransferase [reference value: 3–18 IU/mL]: 48/100 and 181/191, respectively). Their blood glucose levels had been poorly controlled for the last few years (HbA1c 11–12%). Lowdensity liver on computed tomography (CT) is usually seen in NAFLD, but sometimes, in early stage NAFLD, low-density liver is not seen on CT. Gradient dual-echo magnetic resonance imaging (MRI) can effectively discriminate glycogen from fat in the liver (Fig. 1). Therefore, we believe that gradient dual-echo MRI is a powerful tool to distinguish GH from NAFLD in T1DM with hepatomegaly and elevated transaminase.