NAFLD closely associated with risk of severe hypoglycemia in diabetes patients: JAMA

In a new study conducted by Ji-Yeon Lee and team it was found that regardless of weight status, nonalcoholic fatty liver disease (NAFLD) was linked to a greater risk of severe hypoglycemia in people with type 2 diabetes.

The findings of this study were published in the Journal of American Medical Association.

Although nonalcoholic fatty liver disease and hypoglycemia have not been studied in noncirrhotic persons with type 2 diabetes, prior research has shown that liver cirrhosis and hypoglycemia are related. In order to better understand the relationship between NAFLD and severe hypoglycemia in type 2 diabetes patients, this study was carried out.

The National Health Insurance System of South Korea was used in this population-based retrospective cohort analysis. It included people 20 years of age or older who had received a medical health assessment between January 1, 2009, and December 31, 2012 and were identified as having type 2 diabetes. Following up with participants continued through December 31, 2015. Between January 1, 2019, and February 2, 2021, data analysis was done. A substitute marker for NAFLD was the first fatty liver index (FLI). 

The key findings of this study were as follows:

1. 1,125,187 (57.8%) of the 1,946,581 people with type 2 diabetes were male.

2. 45 135 (2.3%) individuals encountered one or more severe hypoglycemia incidents throughout the course of a median (IQR) follow-up of 5.2 (4.1-6.1) years.

3. Individuals with severe hypoglycemia were older and had a lower mean (SD) body mass index than participants without severe hypoglycemia.

4. Regardless of BMI level, patients with NAFLD tended to have less severe hypoglycemia.

5. Although there was a J-shaped connection between FLI and severe hypoglycemia when several clinical variables, including body mass index, were adjusted, the estimated risk of hypoglycemia was greater in people with NAFLD.

6. The connection was stronger among people who were female and underweight.

In conclusion, the Authors found when assessing type 2 diabetes patients' susceptibility to hypoglycemia, the existence of NAFLD should be taken into account.

Reference: 

Lee, J.-Y., Kim, Y., Han, K., Han, E., Lee, B. W., Kang, E. S., Cha, B.-S., Ko, S.-H., & Lee, Y. (2022). Analysis of Severe Hypoglycemia Among Adults With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease. In JAMA Network Open (Vol. 5, Issue 2, p. e220262). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.0262