Correlation of Type 2 Diabetes Mellitus with liver fibrosis on ultrasound elastography: a narrative review

• Main Authors: Wan Chek, Wan Ahmad Firdaus, Haroon, Raihanah
• Format: Proceeding Paper
• Language: English; English
• Published: 2023
• Subjects: RC627 Specialties of Internal Medicine-Metabolic Diseases
• Online Access: http://irep.iium.edu.my/108834/1/MRS%202023%20-%20Abstract%20Book-1.pdf; http://irep.iium.edu.my/108834/2/PC022-Wan%20Ahmad%20Firdaus.pdf; http://irep.iium.edu.my/108834/
• Institution: Universiti Islam Antarabangsa Malaysia

Introduction: Type 2 diabetes mellitus (DM) patients showed higher prevalence of developing non-alcoholic fatty liver disease which can further progress to liver fibrosis due to repetitive liver injury. This may lead to liver cirrhosis with increased risk for hepatocellular carcinoma. Sonographically, liver fibrosis is quantified using elastography which measures the degree of liver stiffness, from F0-F4 stages. F0-F2 stages are interpreted as insignificant, while F3-F4 are considered as significant liver fibrosis. This article reviews the literature surrounding liver fibrosis as a complication of type 2 DM detected by ultrasound elastography. Materials and method: A systematic approach was performed using various search engines such as PubMed, Google Scholar and Elsevier between 2018 to 2022. Results: We reviewed 16 relevant studies out of 41 articles in our analysis. From these articles, all the studies showed that all type 2 DM patients are prone to develop significant liver fibrosis, hence increased liver-related mortality. Five studies showed the sensitivity and specificity of elastography around 80% in diagnosing different stages of liver fibrosis. Two of the studies (by Kwok et al. (2014) from Hong Kong and Lai et al. (2018) from Malaysia) showed correlation between DM and obesity with liver fibrosis on elastography, whereby 70-87% of these patients had histopathologically-proven liver fibrosis after biopsy. Conclusion: Type 2 DM patients are prone to develop significant liver fibrosis. Ultrasound elastography showed excellent diagnostic accuracy to assess the degree of liver fibrosis, potentially eliminating the need for invasive liver biopsy. Hence, liver should be considered as additional macrovascular target end-organ damage potentially affected by type 2 DM. However, future studies are recommended to explore further the effect of different disease control of type 2 DM on the severity of liver fibrosis.