Study Identifies Key Factors Predicting Liver Fibrosis Progression in Type 2 Diabetes with MASLD

Researchers found that an increase in alkaline phosphatase (ALP) levels, an increase in waist circumference, and a reduction in platelet count were significant indicators of worsening liver fibrosis in these patients. The study also highlighted the potential protective role of GLP-1 receptor agonists in slowing liver fibrosis progression.

As liver fibrosis can lead to cirrhosis and increase the risk of liver-related complications, understanding factors that contribute to its progression is critical for improving patient outcomes. Assim A. Alfadda, Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia, and colleagues aimed to examine the factors that predict liver fibrosis progression in patients with T2DM over a minimum follow-up period of three years.

For this purpose, the researchers followed 233 patients whose clinical, laboratory, and liver FibroScan data were analyzed at the end of the study period. The patients were divided into two groups: 42 progressors (18.0%) who experienced liver fibrosis progression, and 191 non-progressors (82.0%). Factors influencing fibrosis progression were identified by comparing the characteristics of these two groups.

Based on the study, the researchers reported the following findings:

• Progressors showed significantly increased levels of aspartate aminotransferase (AST), alkaline phosphatase (ALP), and decreased platelet count.
• Non-progressors exhibited significant decreases in diastolic blood pressure (DBP), body mass index (BMI), waist circumference, gamma-glutamyl transferase (GGT), albumin, alanine aminotransferase (ALT), glycosylated hemoglobin (HbA1c), and fasting blood sugar (FBS).
• Non-progressors also showed an increase in HDL-cholesterol, creatinine, bilirubin, and ALP.
• Baseline parameters predictive of liver fibrosis progression included elevated AST and reduced platelet count.
• Changes from baseline to follow-up revealed that increases in ALP, BMI, waist circumference, and reductions in platelet count were correlated with fibrosis progression.
• The use of GLP-1 receptor agonists was associated with reduced liver fibrosis progression.

"In patients with type 2 diabetes, higher alkaline phosphatase, increased waist circumference, and lower platelet count were predictive of liver fibrosis progression. Progressors exhibited elevated ALP levels and decreased platelet count, while non-progressors showed improvements in waist circumference and glycosylated hemoglobin. Notably, the use of GLP-1 receptor agonists was associated with a reduced risk of liver fibrosis progression," the researchers reported.

"The study reinforces the importance of monitoring specific clinical markers—such as ALP levels, waist circumference, and platelet count—in predicting liver fibrosis progression in T2DM patients with MASLD. The findings also highlight the promising potential of GLP-1 receptor agonists as a protective treatment, offering hope for more effective management of both diabetes and liver health," they concluded.

Reference:

Alfadda, A. A., Alqutub, A. N., Sherbeeni, S. M., Aldosary, A. S., Alqahtani, S. A., Isnani, A., Gul, R., Khaleel, M. S., Alqasim, S. M., & Almaghamsi, A. M. (2024). Predictors of liver fibrosis progression in cohort of type 2 diabetes mellitus patients with MASLD. Journal of Diabetes and its Complications, 108910. https://doi.org/10.1016/j.jdiacomp.2024.108910