Department of Medicine, Huddinge, Karolinska Institutet.
Division of Hepatology, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital.
Eur J Gastroenterol Hepatol. 2021 Nov 1;33(11):1420-1426. doi: 10.1097/MEG.0000000000001882.
It is unclear if improving glycemic control in persons with type 2 diabetes (T2D) also has liver-related effects. We aimed to evaluate if a personalized treatment program associates with improvement of liver-related parameters in persons with advanced T2D in a real-life setting.
Persons with advanced T2D underwent a 4-day personalized treatment program, with the aim of improving glycemic control by dietary advice, instructions on how to achieve optimal glucose control and individualized dosage of medications. Transient elastography was used to estimate liver steatosis and fibrosis. Persons with liver diseases other than non-alcoholic fatty liver disease (NAFLD) were excluded. After 3 months, study participants were offered re-examination.
Ninety-one persons were included. Of these, 75 persons (82%) had controlled attenuation parameter (CAP) measurements of acceptable quality at baseline. Of these, 57 (76%) had NAFLD (defined as >268 dB/m). Twenty-two persons (24%) had elevated liver stiffness (>7.9 kPa), and eight (9%) had liver stiffness above 13.9 kPa, indicating advanced fibrosis. Over a median follow-up of 101 days, mean CAP in persons with NAFLD was reduced by 18.33 dB/m (P = 0.035). In persons with elevated liver stiffness, mean stiffness was reduced by 2.6 kPa (P = 0.047). In linear regression, one-unit improvement in fasting glucose (mg/dl) was associated with a decrease in hepatic steatosis with 0.48 dB/m (adjusted R2 = 0.35, P < 0.01).
The prevalence of NAFLD with advanced fibrosis is high in persons with advanced T2D. Improving glycemic control through a personalized treatment program is associated with a reduction in liver steatosis and stiffness in this cohort.
改善 2 型糖尿病（T2D）患者的血糖控制是否也具有肝脏相关作用尚不清楚。我们旨在评估在真实环境中，对于患有晚期 T2D 的患者，个性化治疗方案是否与改善肝脏相关参数相关。
晚期 T2D 患者接受为期 4 天的个性化治疗方案，旨在通过饮食建议、实现最佳血糖控制的指导以及个体化药物剂量来改善血糖控制。使用瞬时弹性成像来评估肝脂肪变性和纤维化。排除患有除非酒精性脂肪性肝病（NAFLD）以外的肝脏疾病的患者。3 个月后，研究参与者可选择重新检查。
共纳入 91 例患者。其中，75 例（82%）在基线时有可接受质量的受控衰减参数（CAP）测量值。其中，57 例（76%）患有 NAFLD（定义为>268 dB/m）。22 例（24%）肝硬度升高（>7.9 kPa），8 例（9%）肝硬度超过 13.9 kPa，提示存在晚期纤维化。在中位随访 101 天期间，患有 NAFLD 的患者的平均 CAP 降低了 18.33 dB/m（P = 0.035）。在肝硬度升高的患者中，平均硬度降低了 2.6 kPa（P = 0.047）。在线性回归中，空腹血糖（mg/dl）每改善 1 单位，肝脂肪变性减少 0.48 dB/m（调整后的 R2 = 0.35，P < 0.01）。
晚期 T2D 患者中，NAFLD 合并晚期纤维化的患病率很高。通过个性化治疗方案改善血糖控制与该队列中肝脂肪变性和硬度的降低相关。
