Serial transient elastography examinations to monitor patients with type 2 diabetes: A prospective cohort study

Type 2 diabetes is an important risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. Current international guidelines recommend the use of non-invasive tests as initial assessments for NAFLD, but the role of non-invasive tests as monitoring tools has not been established. We aimed to study the role of transient elastography as a monitoring tool in patients with type 2 diabetes. We recruited patients with type 2 diabetes without viral hepatitis or excessive alcohol intake from a complication screening facility in Hong Kong in 2013-2014 and repeated the assessments in 2016-2018. The primary endpoint was an increase of liver stiffness measurement (LSM) to >/=10 kPa. The secondary endpoint was the change in controlled attenuation parameter (CAP). 611 patients with type 2 diabetes and valid LSM (mean age 57.7+/-10.9 years; 342 males [56.0%]) were included in this study (568 also had valid CAP). Overall, there was moderate correlation between baseline and follow-up LSM (r=0.689, P /=10 kPa. Baseline body mass index, alanine aminotransferase (ALT) and ALT were independent factors associated with LSM increase. Among 124 patients with baseline LSM >/=10 kPa, 70 (56.5%) had follow-up LSM /=248 dB/m., Conclusion: The prevalence and incidence of NAFLD in patients with type 2 diabetes are high. Although advanced fibrosis is common in this population, few patients progress to advanced fibrosis in 3 years. Future studies should define the optimal surveillance interval in diabetic patients.