Prevalence of elevated liver enzymes in adults with type 1 diabetes: A multicentre analysis of the German/Austrian DPV database

Aims To assess the prevalence of elevated liver enzymes in adults with type 1 diabetes mellitus (T1DM) in routine clinical care and the association with cardiovascular risk profile in the Diabetes-Prospective-Documentation (DPV) network in Germany and Austria. Methods This cross sectional observational study from the DPV registry includes data from 45519 adults with T1DM at 478 centers up to 9/2016. Liver enzyme measurements were available in 9226 (29%) patients at 270 centers and were analyzed for increased alanine aminotransferase (ALT; men > 50 U/l, women: >35U/l) and/or aspartate aminotransferase (AST; men >50 U/l, women >35U/l) and/or gamma-glutamyltransferase (GGT; men >60U/l, women > 40 U/l). A subgroup analysis in patients in whom two or more ALT measurements were available (n = 2335, 25%) and whose ALT was increased at least twice (men:>30 U/l, women >19U/) was performed. Associations with glycemic control, cardiovascular risk factors and late complications were investigated with multiple regression analyses. Results Twenty percent (19.8%, n = 1824) had increased liver enzyme(s) on one or more occasions. Increased liver enzymes were associated with worse glycemic control and higher BMI (both p < 0.0001), dyslipidemia (OR:1.75, 95%CI: 1.54-2.0), hypertension (OR:1.48, 95%CI:1.31-1.68), myocardial infarction (OR:1.49; 95%CI:1.17-1.91) and end stage renal disease (OR:1.59; 95%CI:1.17-2.17). ALT was increased twice in 29% and was associated with worse glycemic control (p < 0.0001), higher BMI (p < 0.0001), hypertension (OR:1.58, 95%CI:1.26-1.97) and dyslipidemia (OR:1.89, 95%CI:1.51-2.37). Conclusions In this clinical audit in adults with T1DM, elevated liver enzymes on routine assessment were associated with a less favorable cardiovascular risk profile and with poorer glycemic control.