Global Epidemiology and Characteristics of Metabolic Dysfunction-associated Steatotic Liver Disease in Type 1 Diabetes Mellitus: An Updated Systematic Review and Meta-analysis.

BACKGROUND & AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is often overlooked in patients with type 1 diabetes mellitus (T1DM). Our study aims to provide a comprehensive overview of the burden of MASLD in T1DM by assessing the prevalence of MASLD and its advanced forms in individuals with T1DM.

METHODS

We systematically searched PubMed and Embase databases (from inception to May 5, 2024) for original articles on the prevalence or characteristics of MASLD (as detected by blood biomarkers/scores, imaging techniques, or liver biopsy) in adults with T1DM. Data were extracted, and we performed a meta-analysis of proportions using generalized linear mixed model, and pairwise meta-analysis using the DerSimonian-Laird method. Heterogeneity was investigated with further subgroup and meta-regression analyses, and publication bias was assessed.

RESULTS

We identified 23 studies for a total of 13,006 individuals with T1DM. Of these, 22.24% (95% confidence interval [CI], 15.62-30.66; I = 99.2%) had MASLD. Significant fibrosis (≥F2) and advanced fibrosis (≥F3) were found in 13.25% (95% CI, 11.15-15.67; I = 0%) and 5.12% (95% CI, 3.78-6.91; I = 0%) of patients with T1DM and MASLD, respectively. Patients with MASLD and T1DM were more likely to be older, overweight, male, have a longer duration of diabetes, require higher daily doses of insulin, have metabolic dysfunction, and were at a higher risk of microvascular complications.

CONCLUSION

MASLD is relatively common in T1DM. Patients with MASLD-T1DM have a distinct clinical profile compared with those with T1DM, with only a small proportion having significant or advanced fibrosis.