Steatotic liver disease increases risk of diabetic nephropathy and neuropathy in T2D patients: Study

A new study published in the journal of Frontiers in Endocrinology showed that patients with type 2 diabetes mellitus who have steatotic liver disease (SLD) are more likely to experience diabetic microvascular complications.

The prevalence of type 2 diabetes (T2D) is rising globally and presents a significant public health concern. According to the most recent Delphi consensus statement, steatotic liver disease is the general term used to refer to the several causes of steatosis, including alcoholic and metabolic- related steatosis.

Although there is little longitudinal evidence in large samples, cross-sectional studies have shown that steatotic liver disease is linked to common diabetic microvascular problems. Thus, this study examined whether glycemic control acted as a mediating factor in the relationship between SLDs and the risk of microvascular problems in patients with type 2 diabetes in a prospective manner.

At baseline, there were 25,630 T2D patients in the population-based cohort, which was based on the UK Biobank project. A fatty liver index of 60 or more was considered SLD. Poor glycemic control was defined as a glycated hemoglobin level of > 7% (53 mmol/mol). Total incidence diabetic microvascular problems, which are the first manifestations of diabetes retinopathy, diabetic neuropathy, and/or diabetic nephropathy, were the main result. To investigate whether glycemic control mediated the relationship between SLDs and diabetic microvascular problems, mediation analysis was used.

The average age of the research participants was 59.6 years, and 58.1% of them were men. Microvascular problems were identified in 5,171 patients over a median follow-up duration of 12.1 years. SLD participants had an HR of 1.15 (95% CI: 1.04, 1.27) for total microvascular complications, 1.20 (95% CI: 1.06, 1.35) for diabetic nephropathy, 1.05 (95% CI: 0.91, 1.21) for diabetic retinopathy, and 1.46 (95% CI: 1.15, 1.86) for diabetic neuropathy when compared to non-SLD participants.

According to the findings of the mediation study, there was a 22.5% (95% CI: 10.4%, 91.0%) mediating proportion of glycemic control in the relationship between the SLD group and all diabetic microvascular problems. Overall, in T2D patients, SLD was linked to a higher risk of microvascular problems, particularly diabetic neuropathy and diabetic nephropathy. The relationship between SLDs and diabetic microvascular problems was partially mediated by glucose control.

Source:

Liu, L., You, Q., Yu, W., Lett, A. M., Wu, Y., Zeng, J., Fan, M., Chen, B., Fu, W., & Xu, S. (2025). Association between steatotic liver disease and microvascular complications in individuals with type 2 diabetes: a cohort study in the UK Biobank. Frontiers in Endocrinology, 16. https://doi.org/10.3389/fendo.2025.1554798