Ultrasound and transient elastography: Screening exams for type 2 diabetes mellitus patients

Liver stiffness assessment should be routinely performed on individuals with Type 2 diabetes mellitus (DM), as these patients are susceptible to developing nonalcoholic fatty liver disease (NAFLD). Gastroenterologists from Romania recommend using ultrasound and elastography to identify and assess the severity of liver steatosis and fibrosis among their patients. Their study findings were published in the June 2016 issue of the Journal of Gastrointestinal Liver Disease.

Diabetes and obesity have reached epidemic proportions in Western societies, and the number of patients afflicted by either condition continues to rise. A large percentage of patients with DM are obese and may develop liver steatosis, the abnormal retention of triglycerides and lipids in liver cells. Patients who have NAFLD may develop nonalcoholic steatohepatis and subsequently liver cirrhosis.

Lead author Ioan Sporea, MD, of the Department of Gastroenterology and Hepatology of the Victor Babeş aUniversity of Medicine and Pharmacy in Timişoara, and colleagues, state that NAFLD will become one of the most important problems to confront hepatologists as a leading cause of liver cirrhosis. Biopsy, the gold standard for diagnosis, may become impractical to perform on all patients. Because inflammation can differentiate sever from simple steatosis, the authors conducted a study of nearly 300 patients to assess the extent and severity of liver steatosis using ultrasound, and of liver fibrosis using transient elastography.

The 298 patients with Type 2 DM were enrolled in the study during a six month period in 2013. An additional 109 healthy volunteers and 43 hospitalized patients without liver disease completed the study cohort. Based on ultrasound findings, they were grouped into one of four steatosis categories ranging from none to severe. Liver stiffness as a marker of fibrosis was evaluated by transient elastography.

A total of 260 patients (87.2%) were identified as having steatosis: 44 patients had severe and 118 patients had moderate steatosis. 56, or 18.8% patients diagnosed with NAFLD had significant fibrosis. Liver stiffness suggestive of cirrhosis was identified in 41 (13.8%) patients. An evaluation to determine if risk of fibrosis increased in NAFLD patients who were obese and had type 2 DM determined that obesity, steatosis, higher alanine aminotransferase, and hypertriglyceridemia were independently associated with liver stiffness values. There were no significant differences between the mean liver stiffness value in obese, underweight, or normal weight individuals in the control group.

The authors recommend that ultrasound be used in daily practice to screen diabetic patients for steatosis because of its availability, low cost, rapid exam time of approximately five minutes, and diagnostic accuracy. They also recommend the use of ultrasound-based elastographic techniques; ie, transient elastography for liver fibrosis assessment.

REFERENCE

1. Sporea I, Mare R, Lupuşoru R, et al. Liver stiffness evaluation by transient elastography in type 2 diabetes mellitus patients with ultrasound-proven steatosis. J Gastrointestin Liver Dis. 2016 25;2: 167-174.