Serial Transient Elastography Examinations to Monitor Patients With Type 2 Diabetes: A Prospective Cohort Study
Background and Aims Type 2 diabetes is an important risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. Current international guidelines recommend the use of noninvasive tests as initial assessments for NAFLD, but the role of noninvasive tests as monitoring tools has not...
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| Veröffentlicht in: | Hepatology (Baltimore, Md.) Md.), 2020-10, Vol.72 (4), p.1230-1241 |
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| creator | Lee, Hye Won Wong, Grace Lai‐Hung Kwok, Raymond Choi, Kai Chow Chan, Carmen Ka‐Man Shu, Sally She‐Ting Leung, Julie Ka‐Yu Chim, Angel Mei‐Ling Luk, Andrea On‐Yan Ma, Ronald Ching‐Wan Chan, Henry Lik‐Yuen Chan, Juliana Chung‐Ngor Kong, Alice Pik‐Shan Wong, Vincent Wai‐Sun |
| description | Background and Aims
Type 2 diabetes is an important risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. Current international guidelines recommend the use of noninvasive tests as initial assessments for NAFLD, but the role of noninvasive 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.
Approach and Results
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 the controlled attenuation parameter (CAP). A total of 611 patients with type 2 diabetes and a valid LSM (mean age, 57.7 ± 10.9 years; 342 men [56.0%]) were included in this study (568 also had a valid CAP). Overall, there was moderate correlation between the baseline and follow‐up LSM (r = 0.689, P |
| doi_str_mv | 10.1002/hep.31142 |
| format | Article |
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Type 2 diabetes is an important risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. Current international guidelines recommend the use of noninvasive tests as initial assessments for NAFLD, but the role of noninvasive 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.
Approach and Results
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 the controlled attenuation parameter (CAP). A total of 611 patients with type 2 diabetes and a valid LSM (mean age, 57.7 ± 10.9 years; 342 men [56.0%]) were included in this study (568 also had a valid CAP). Overall, there was moderate correlation between the baseline and follow‐up LSM (r = 0.689, P < 0.001). Among 487 patients with a baseline LSM <10 kPa, 21 (4.3%) had a follow‐up LSM ≥10 kPa. Baseline body mass index, alanine aminotransferase (ALT), and ∆ALT were independent factors associated with LSM increase. Among 124 patients with a baseline LSM ≥10 kPa, 70 (56.5%) had a follow‐up LSM <10 kPa. Among 198 patients with a CAP <248 dB/m at baseline, 103 (52.0%) had a CAP increased to ≥248 dB/m.
Conclusions
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 patients with diabetes.</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.31142</identifier><identifier>PMID: 31991487</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Alanine ; Alanine transaminase ; Alanine Transaminase - blood ; Body Mass Index ; Cohort analysis ; Diabetes ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnostic imaging ; Elasticity Imaging Techniques - methods ; Fatty liver ; Female ; Fibrosis ; Hepatitis ; Hepatology ; Humans ; Liver Cirrhosis - epidemiology ; Liver diseases ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease - diagnostic imaging ; Non-alcoholic Fatty Liver Disease - epidemiology ; Non-alcoholic Fatty Liver Disease - etiology ; Prospective Studies ; Risk factors</subject><ispartof>Hepatology (Baltimore, Md.), 2020-10, Vol.72 (4), p.1230-1241</ispartof><rights>2020 by the American Association for the Study of Liver Diseases.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-85fdad0828e3d56fa95da74b6071fe15fd73e49859321c8eefc06065f61cae523</citedby><cites>FETCH-LOGICAL-c3532-85fdad0828e3d56fa95da74b6071fe15fd73e49859321c8eefc06065f61cae523</cites><orcidid>0000-0003-2215-9410 ; 0000-0002-2863-9389</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhep.31142$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhep.31142$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27926,27927,45576,45577</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31991487$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Hye Won</creatorcontrib><creatorcontrib>Wong, Grace Lai‐Hung</creatorcontrib><creatorcontrib>Kwok, Raymond</creatorcontrib><creatorcontrib>Choi, Kai Chow</creatorcontrib><creatorcontrib>Chan, Carmen Ka‐Man</creatorcontrib><creatorcontrib>Shu, Sally She‐Ting</creatorcontrib><creatorcontrib>Leung, Julie Ka‐Yu</creatorcontrib><creatorcontrib>Chim, Angel Mei‐Ling</creatorcontrib><creatorcontrib>Luk, Andrea On‐Yan</creatorcontrib><creatorcontrib>Ma, Ronald Ching‐Wan</creatorcontrib><creatorcontrib>Chan, Henry Lik‐Yuen</creatorcontrib><creatorcontrib>Chan, Juliana Chung‐Ngor</creatorcontrib><creatorcontrib>Kong, Alice Pik‐Shan</creatorcontrib><creatorcontrib>Wong, Vincent Wai‐Sun</creatorcontrib><title>Serial Transient Elastography Examinations to Monitor Patients With Type 2 Diabetes: A Prospective Cohort Study</title><title>Hepatology (Baltimore, Md.)</title><addtitle>Hepatology</addtitle><description>Background and Aims
Type 2 diabetes is an important risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. Current international guidelines recommend the use of noninvasive tests as initial assessments for NAFLD, but the role of noninvasive 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.
Approach and Results
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 the controlled attenuation parameter (CAP). A total of 611 patients with type 2 diabetes and a valid LSM (mean age, 57.7 ± 10.9 years; 342 men [56.0%]) were included in this study (568 also had a valid CAP). Overall, there was moderate correlation between the baseline and follow‐up LSM (r = 0.689, P < 0.001). Among 487 patients with a baseline LSM <10 kPa, 21 (4.3%) had a follow‐up LSM ≥10 kPa. Baseline body mass index, alanine aminotransferase (ALT), and ∆ALT were independent factors associated with LSM increase. Among 124 patients with a baseline LSM ≥10 kPa, 70 (56.5%) had a follow‐up LSM <10 kPa. Among 198 patients with a CAP <248 dB/m at baseline, 103 (52.0%) had a CAP increased to ≥248 dB/m.
Conclusions
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 patients with diabetes.</description><subject>Aged</subject><subject>Alanine</subject><subject>Alanine transaminase</subject><subject>Alanine Transaminase - blood</subject><subject>Body Mass Index</subject><subject>Cohort analysis</subject><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - diagnostic imaging</subject><subject>Elasticity Imaging Techniques - methods</subject><subject>Fatty liver</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Hepatitis</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Liver Cirrhosis - epidemiology</subject><subject>Liver diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Non-alcoholic Fatty Liver Disease - diagnostic imaging</subject><subject>Non-alcoholic Fatty Liver Disease - epidemiology</subject><subject>Non-alcoholic Fatty Liver Disease - etiology</subject><subject>Prospective Studies</subject><subject>Risk factors</subject><issn>0270-9139</issn><issn>1527-3350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1P4zAQhq0VCLqFw_4BZInLcgj4I05ibqjbpUhFVKKIo-Umk61RGgfb2SX_HkPLHpA4jTTz6NHMvAj9oOScEsIu1tCdc0pT9g2NqGB5wrkge2hEWE4SSbk8RN-9fyKEyJQVB-iQUylpWuQjZO_BGd3gpdOtN9AGPG20D_aP0916wNMXvTGtDsa2HgeLb21rgnV4EVsR9vjRhDVeDh1ghn8ZvYIA_hJf4YWzvoMymL-AJ3ZtXcD3oa-GI7Rf68bD8a6O0cPv6XIyS-Z31zeTq3lScsFZUoi60hUpWAG8Elmtpah0nq4yktMaaJzmHFJZCMkZLQuAuiQZyUSd0VKDYHyMfm69nbPPPfigNsaX0DS6Bdt7xXhaMBb9NKKnn9An27s2bqdYKkguqcizSJ1tqTJe5h3UqnNmo92gKFFvKaiYgnpPIbInO2O_2kD1n_x4ewQutsA_08DwtUnNpout8hUhB5DQ</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Lee, Hye Won</creator><creator>Wong, Grace Lai‐Hung</creator><creator>Kwok, Raymond</creator><creator>Choi, Kai Chow</creator><creator>Chan, Carmen Ka‐Man</creator><creator>Shu, Sally She‐Ting</creator><creator>Leung, Julie Ka‐Yu</creator><creator>Chim, Angel Mei‐Ling</creator><creator>Luk, Andrea On‐Yan</creator><creator>Ma, Ronald Ching‐Wan</creator><creator>Chan, Henry Lik‐Yuen</creator><creator>Chan, Juliana Chung‐Ngor</creator><creator>Kong, Alice Pik‐Shan</creator><creator>Wong, Vincent Wai‐Sun</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2215-9410</orcidid><orcidid>https://orcid.org/0000-0002-2863-9389</orcidid></search><sort><creationdate>202010</creationdate><title>Serial Transient Elastography Examinations to Monitor Patients With Type 2 Diabetes: A Prospective Cohort Study</title><author>Lee, Hye Won ; Wong, Grace Lai‐Hung ; Kwok, Raymond ; Choi, Kai Chow ; Chan, Carmen Ka‐Man ; Shu, Sally She‐Ting ; Leung, Julie Ka‐Yu ; Chim, Angel Mei‐Ling ; Luk, Andrea On‐Yan ; Ma, Ronald Ching‐Wan ; Chan, Henry Lik‐Yuen ; Chan, Juliana Chung‐Ngor ; Kong, Alice Pik‐Shan ; Wong, Vincent Wai‐Sun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-85fdad0828e3d56fa95da74b6071fe15fd73e49859321c8eefc06065f61cae523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Alanine</topic><topic>Alanine transaminase</topic><topic>Alanine Transaminase - blood</topic><topic>Body Mass Index</topic><topic>Cohort analysis</topic><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - diagnostic imaging</topic><topic>Elasticity Imaging Techniques - methods</topic><topic>Fatty liver</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Hepatitis</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Liver Cirrhosis - epidemiology</topic><topic>Liver diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Non-alcoholic Fatty Liver Disease - diagnostic imaging</topic><topic>Non-alcoholic Fatty Liver Disease - epidemiology</topic><topic>Non-alcoholic Fatty Liver Disease - etiology</topic><topic>Prospective Studies</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Hye Won</creatorcontrib><creatorcontrib>Wong, Grace Lai‐Hung</creatorcontrib><creatorcontrib>Kwok, Raymond</creatorcontrib><creatorcontrib>Choi, Kai Chow</creatorcontrib><creatorcontrib>Chan, Carmen Ka‐Man</creatorcontrib><creatorcontrib>Shu, Sally She‐Ting</creatorcontrib><creatorcontrib>Leung, Julie Ka‐Yu</creatorcontrib><creatorcontrib>Chim, Angel Mei‐Ling</creatorcontrib><creatorcontrib>Luk, Andrea On‐Yan</creatorcontrib><creatorcontrib>Ma, Ronald Ching‐Wan</creatorcontrib><creatorcontrib>Chan, Henry Lik‐Yuen</creatorcontrib><creatorcontrib>Chan, Juliana Chung‐Ngor</creatorcontrib><creatorcontrib>Kong, Alice Pik‐Shan</creatorcontrib><creatorcontrib>Wong, Vincent Wai‐Sun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Hye Won</au><au>Wong, Grace Lai‐Hung</au><au>Kwok, Raymond</au><au>Choi, Kai Chow</au><au>Chan, Carmen Ka‐Man</au><au>Shu, Sally She‐Ting</au><au>Leung, Julie Ka‐Yu</au><au>Chim, Angel Mei‐Ling</au><au>Luk, Andrea On‐Yan</au><au>Ma, Ronald Ching‐Wan</au><au>Chan, Henry Lik‐Yuen</au><au>Chan, Juliana Chung‐Ngor</au><au>Kong, Alice Pik‐Shan</au><au>Wong, Vincent Wai‐Sun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serial Transient Elastography Examinations to Monitor Patients With Type 2 Diabetes: A Prospective Cohort Study</atitle><jtitle>Hepatology (Baltimore, Md.)</jtitle><addtitle>Hepatology</addtitle><date>2020-10</date><risdate>2020</risdate><volume>72</volume><issue>4</issue><spage>1230</spage><epage>1241</epage><pages>1230-1241</pages><issn>0270-9139</issn><eissn>1527-3350</eissn><abstract>Background and Aims
Type 2 diabetes is an important risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. Current international guidelines recommend the use of noninvasive tests as initial assessments for NAFLD, but the role of noninvasive 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.
Approach and Results
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 the controlled attenuation parameter (CAP). A total of 611 patients with type 2 diabetes and a valid LSM (mean age, 57.7 ± 10.9 years; 342 men [56.0%]) were included in this study (568 also had a valid CAP). Overall, there was moderate correlation between the baseline and follow‐up LSM (r = 0.689, P < 0.001). Among 487 patients with a baseline LSM <10 kPa, 21 (4.3%) had a follow‐up LSM ≥10 kPa. Baseline body mass index, alanine aminotransferase (ALT), and ∆ALT were independent factors associated with LSM increase. Among 124 patients with a baseline LSM ≥10 kPa, 70 (56.5%) had a follow‐up LSM <10 kPa. Among 198 patients with a CAP <248 dB/m at baseline, 103 (52.0%) had a CAP increased to ≥248 dB/m.
Conclusions
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 patients with diabetes.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31991487</pmid><doi>10.1002/hep.31142</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-2215-9410</orcidid><orcidid>https://orcid.org/0000-0002-2863-9389</orcidid></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via Wiley Online Library |
| subjects | Aged Alanine Alanine transaminase Alanine Transaminase - blood Body Mass Index Cohort analysis Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - diagnostic imaging Elasticity Imaging Techniques - methods Fatty liver Female Fibrosis Hepatitis Hepatology Humans Liver Cirrhosis - epidemiology Liver diseases Male Middle Aged Non-alcoholic Fatty Liver Disease - diagnostic imaging Non-alcoholic Fatty Liver Disease - epidemiology Non-alcoholic Fatty Liver Disease - etiology Prospective Studies Risk factors |
| title | Serial Transient Elastography Examinations to Monitor Patients With Type 2 Diabetes: A Prospective Cohort Study |
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