ArticleThe Relationship Between Glycaemic Control and Non-Alcoholic Fatty Liver Disease in Nigerian Type 2 Diabetic Patients
Introduction
About 347 million people worldwide have been diagnosed with diabetes mellitus (DM), while the World Health Organization (WHO) projects that it will be the seventh leading cause of death by 2030.1 It is a metabolic disorder characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both.1 High insulin resistance and/or deficit in insulin secretion that is associated with DM increases the activity of the enzyme lipase.2 This gradual development of impairment in free fatty acid (FFA) metabolism leads to increased levels of FFA in excess of what the liver can oxidize. These are consequently deposited in the liver, a condition known as non-alcoholic fatty liver disease (NAFLD). Simple NAFLD can become non-alcoholic steatohepatitis when the liver cells get inflamed, progressing into fibrosis and eventually cirrhosis and/or hepatocellular carcinoma. Eventually, this greatly impairs the quality of life of a diabetic, culminating in end stage liver disease. Therefore, early detection and prompt management of NAFLD can greatly improve the quality of life of diabetics.3
Liver biopsy is the gold standard for diagnosing NAFLD but this method is invasive and cannot be used for screening purposes.4 Ultrasound (USS) has been shown to be sensitive in detecting fatty liver, and since it is safe, available, affordable, and does not require the use of ionizing radiation, it is the preferred method of choice for screening patients for NAFLD.5 Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) and Spectroscopy are other alternative imaging techniques for the detection of fatty liver. They have however failed to show better accuracy than ultrasonography,5 and their high cost and other disadvantages such as radiation in CT and claustrophobic effects in MRI, limit their usefulness as screening tools.5
NAFLD in T2DM subjects has been well studied among Asians, Indians and Caucasians.4, 6, 7, 8, 9, 10, 11 However, the few African studies on the subject matter majorly addressed its prevalence and some associated risk factors.12, 13 The present study aimed to determine the relationship between NAFLD and glycaemic control levels in Nigerian T2DM subjects.
Section snippets
Recruitment of study subjects
The study was approved by the Review Board of our institution and written informed consent was obtained from all study participants. Eighty consecutive T2DM patients aged 40-80 years old without history of significant alcohol intake (less than 20 g/day for females and 30 g/day for males14) were recruited from the Endocrinology clinic of the hospital. The sample size was calculated by Leslie formula (with 10% attrition rate factored in) using a reported prevalence rate of 4.7% in T2DM in a
Results and discussion
The demographics of the 80 participants with T2DM recruited are given in Table 1. On the average, the participants had a mean age of 60.9 ± 1.15 years, an overweight BMI, a diabetic FBG, high HbA1c and a normal liver span (Table 2). The prevalence of fatty liver was not significantly different (p = 0.852) between the male and female subjects (Table 3).
The FBG level was not significantly different (p = 0.291) between diabetics with NAFLD and those without. Also, the prevalence of NAFLD was not
Implications
NAFLD impairs the quality of life of a diabetic, and can lead to end stage liver disease. Early detection and prompt management of NAFLD can greatly improve the quality of life of diabetics. Knowing the effect of glycaemic control on NAFLD will help the clinicians make better decisions on management of their diabetic patients. This article helps gastroenterologists, endocrinologist, nutritionists and public health authorities.
Acknowledgements
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2021, The Lancet Gastroenterology and HepatologyCitation Excerpt :This yields an estimated annual percentage change in age-standardised prevalence from 1990 to 2017 of 0·69 (95% CI 0·63–0·75).42 NAFLD risk factors, including obesity and type 2 diabetes, are increasing in the region.43–46 In Nigeria, NAFLD prevalence has been reported as 9·5–16·7% in people with type 2 diabetes and 1·2–4·5% in people without diabetes.45,47
Incorporating fatty liver disease in multidisciplinary care and novel clinical trial designs for patients with metabolic diseases
2021, The Lancet Gastroenterology and HepatologyCitation Excerpt :Furthermore, growing evidence indicates that the coexistence of MAFLD renders type 2 diabetes more difficult to manage and development of chronic vascular complications of diabetes is more frequent than for patients without MAFLD. For example, concomitant MAFLD in patients with type 2 diabetes makes it harder to get adequate blood glucose control than for patients without MAFLD40 and, independently of traditional cardiometabolic risk factors (eg, sex, age, smoking, diabetes duration, hyperlipidaemia), increases the risk of cardiovascular disease (ie, approximately double the risk),41 ventricular arrhythmias (ie, 3·5 times increased risk),42 CKD (ie, approximately 1·9 times increased risk),43 proliferative or laser-treated diabetic retinopathy (ie, 1·7 times increased risk), and diabetic polyneuropathy (ie, approximately 5 times increased risk).44 Notably, as also supported by the previously mentioned meta-analysis,37 the severity of MAFLD is associated with the risk of incident type 2 diabetes.
Conflicts of interest: The authors declare no conflicts of interest to disclose.
- 1
Poster address: Department of Radiology, OAU Teaching Hospitals Complex, PMB 5538, Ile Ife, Osun State, Nigeria.