Aim

We examined whether different insulin administration modalities, i.e., multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII by insulin pumps), are differently associated with the risk of having metabolic dysfunction-associated fatty liver disease (MAFLD), with or without coexisting significant liver fibrosis (assessed by validated non-invasive biomarkers), in adults with type 1 diabetes mellitus (T1DM).

Methods

We conducted a retrospective, multicenter, cross-sectional study involving 1,417 adult individuals with established T1DM treated with MDI or CSII. We calculated hepatic steatosis index (HSI) and fibrosis (FIB)-4 index for non-invasively detecting MAFLD (defined by HSI >36), with or without coexisting significant fibrosis (defined by FIB-4 index ≥ 1.3 or <1.3, respectively).

Results

Compared to the MDI group (n = 1,161), insulin-pump users (n = 256; 18.1%) were more likely to be younger (mean age: 40 vs. 48 years, P < 0.001), had better glycemic control (mean hemoglobin A1c: 7.7% vs. 7.9%, P = 0.025) and a markedly lower prevalence of MAFLD with coexisting significant fibrosis (2.7% vs. 8.1%, P = 0.010), but a comparable prevalence of MAFLD without fibrosis. In multinomial logistic regression analysis, CSII therapy was associated with a ∼70%-lower risk of MAFLD with significant fibrosis (unadjusted odds ratio 0.32, 95% confidence interval 0.14–0.70; P = 0.004), but this association was no longer significant after adjustment for age, hemoglobin A1c and other potential confounders.

Conclusion

The lower prevalence of MAFLD with coexisting significant fibrosis we observed in adults with T1DM using CSII therapy, compared to those using MDI therapy, is primarily mediated by inter-group differences in age.

中文翻译：

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成人 1 型糖尿病患者不同胰岛素给药方式与代谢功能障碍相关脂肪肝之间的关联

目的

我们研究了不同的胰岛素给药方式，即每日多次注射（MDI）或连续皮下胰岛素输注（通过胰岛素泵进行CSII）是否与患有代谢功能障碍相关脂肪肝病（MAFLD）的风险存在不同的相关性，无论是否患有代谢功能障碍相关的脂肪肝病（MAFLD）。成人 1 型糖尿病 (T1DM) 患者同时存在显着的肝纤维化（通过经过验证的非侵入性生物标志物评估）。

方法

我们进行了一项回顾性、多中心、横断面研究，涉及 1,417 名患有 T1DM 且接受 MDI 或 CSII 治疗的成年个体。我们计算了肝脂肪变性指数 (HSI) 和纤维化 (FIB)-4 指数，用于无创检测 MAFLD（定义为 HSI >36），伴或不伴共存显着纤维化（定义为 FIB-4 指数分别≥ 1.3 或 <1.3） ）。

结果

与 MDI 组 ( n  = 1,161) 相比，胰岛素泵使用者 ( n  = 256; 18.1%) 更可能更年轻（平均年龄：40 岁 vs. 48 岁，P < 0.001），血糖控制更好（平均A1c 血红蛋白：7.7% vs. 7.9%，P  = 0.025），并存显着纤维化的 MAFLD 患病率明显较低（2.7% vs. 8.1%，P  = 0.010），但无纤维化的 MAFLD 患病率相当。在多项 Logistic 回归分析中，CSII 治疗与伴有显着纤维化的 MAFLD 风险降低约 70% 相关（未调整优势比 0.32，95% 置信区间 0.14–0.70；P  = 0.004），但这种相关性在治疗后不再显着。调整年龄、血红蛋白 A1c 和其他潜在的混杂因素。

结论

与使用 MDI 治疗的患者相比，我们在使用 CSII 治疗的 T1DM 成人患者中观察到 MAFLD 并伴有显着纤维化的患病率较低，这主要是由组间年龄差异介导的。