Higher haemoglobin glycation index indicates higher NAFLD risk in type 2 diabetes patients

In the cross-sectional study involving participants with type 2 diabetes, the researchers found that HGI had a significant association with NAFLD, which remained even after adjustment for various risk factors linked with NAFLD. A higher HGI suggested an increased risk of developing NAFLD in type 2 diabetes patients.

NAFLD is one of the most widespread liver diseases globally. It encompasses a spectrum of conditions varying from simple steatosis without inflammation to NASH (non-alcoholic steatohepatitis) and hepatocellular carcinoma. Additionally, there is a global increase in the prevalence of NAFLD due to high diabetes prevalence. Studies have shown a significant correlation between NAFLD and T2DM. Therefore, it is essential to identify the parameters associated with a high NAFLD risk in patients with diabetes.

The haemoglobin glycation index represents the disparity between actual glycated haemoglobin (HbA1c) measurements and predicted HbA1c. It serves as a proxy for the degree of non-enzymatic glycation of haemoglobin, which has been demonstrated to be correlated positively with diabetic comorbidities.

Jingqiu Cui, Tianjin Medical University General Hospital, Tianjin, China, and colleagues, therefore, investigated the relationship between HGI and NAFLD, along with other relevant biological markers in diabetes patients.

The study involved 3,191 adults diagnosed with T2DM. The predicted glycated haemoglobin levels were calculated based on fasting blood glucose levels. The correlation between the HGI and NAFLD was examined by conducting a multivariate binary logistic regression analysis. The diagnosis of hepatic steatosis was done using ultrasonography.

The authors reported the following findings:

• Among all participants, 55.91% were diagnosed with NAFLD.
• Participants with confirmed NAFLD showed elevated body mass index, diastolic blood pressure, liver enzyme, total cholesterol, triglyceride, low-density lipoprotein and uric acid levels compared with those without NAFLD.
• In the unadjusted model, participants in the last tertile of HGI were 1.40-fold more likely to develop NAFLD than those in the first tertile.
• In the fully adjusted model, those in the last tertile of HGI had a 39% increased risk of liver steatosis compared with the confidence interval in the first tertile of HGI.

"We found an association between NAFLD and HGI levels in type 2 diabetes patients," the researchers wrote. "These findings have important implications for the NAFLD treatment and management in diabetic individuals."

The findings imply that by including HGI as an assessment of blood sugar control alongside traditional indicators such as HbA1c, clinicians can more comprehensively understand glycemic fluctuations, potentially guiding appropriate treatment strategies and preventing misinterpretations.

However, the researchers conclude that there is no clarity on the causative relationship between HGI levels and NAFLD in diabetes patients and requires further investigation.

Reference:

Wang, M., Li, S., Zhang, X., Li, X., & Cui, J. Association between hemoglobin glycation index and non-alcoholic fatty liver disease in the patients with type 2 diabetes mellitus. Journal of Diabetes Investigation. https://doi.org/10.1111/jdi.14066