Purpose

Metabolic dysfunction-associated steatotic liver disease (MASLD) may have distinctive pathophysiological features in type 1 diabetes (T1D). We evaluated the independent role of blood glucose control on MASLD in T1D.

Methods

In a cross-sectional study on 659 T1D adult patients, MASLD was assessed by the Fatty Liver Index (FLI) and the Hepatic Steatosis Index (HSI). Anthropometric, biochemical, and clinical parameters were retrieved from electronic records. Blood glucose control status was evaluated by dividing participants into subgroups according to the median value of HbA1c [7.6% (60 mmol/mol)], and this analysis was repeated excluding overweight/obese patients.

Results

Patients with HbA1c above 7.6% (60 mmol/mol) showed significantly higher MASLD indices (HSI 38 ± 6 vs. 36 ± 5, p < 0.001; FLI 26 ± 26 vs.19 ± 19, p < 0.001), and higher proportions of MASLD identified by HSI (57 vs. 44%, p < 0.001) and FLI (14 vs. 7%, p < 0.001) than patients with HbA1c below 7.6% (60 mmol/mol). Similar results were obtained for HSI after the exclusion of overweight/obese patients. Stepwise linear regression analysis confirmed that HbA1c was independently associated with HSI (r = 0.496, p = 0.009) and FLI (r = 0.722, p = 0.007); waist circumference with HSI (r = 0.492, p < 0.001); and waist circumference (r = 0.700, p < 0.001), HDL cholesterol (r = 0.719, p < 0.001), and LDL cholesterol (r = 0.712, p < 0.001) with FLI.

Conclusions

Blood glucose control is a main factor associated with MASLD in adults with T1D, also independently of overweight and obesity. Appropriate therapeutic strategies focused on tight blood glucose control may also be needed for the prevention and treatment of MASLD in T1D.

中文翻译：

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1 型糖尿病患者的血糖控制和代谢功能障碍相关的脂肪肝病

目的

代谢功能障碍相关的脂肪肝病 (MASLD) 在 1 型糖尿病 (T1D) 中可能具有独特的病理生理学特征。我们评估了血糖控制对 T1D 中 MASLD 的独立作用。

方法

在一项针对 659 名 T1D 成年患者的横断面研究中，通过脂肪肝指数 (FLI) 和肝脂肪变性指数 (HSI) 评估 MASLD。从电子记录中检索人体测量、生化和临床参数。根据 HbA1c 中值 [7.6% (60 mmol/mol)] 将参与者分为亚组来评估血糖控制状态，并重复该分析，排除超重/肥胖患者。

结果

HbA1c 高于 7.6% (60 mmol/mol) 的患者表现出显着较高的 MASLD 指数（HSI 38 ± 6 vs. 36 ± 5，p < 0.001；FLI 26 ± 26 vs.19 ± 19，p < 0.001），并且比例较高与 HbA1c 低于 7.6% (60 mmol/mol) 的患者相比，通过 HSI（57% vs. 44%，p < 0.001）和 FLI（14 vs. 7%，p < 0.001）识别的 MASLD 的发生率更高。排除超重/肥胖患者后，HSI 也获得了类似的结果。逐步线性回归分析证实，HbA1c 与 HSI (r = 0.496，p = 0.009) 和 FLI (r = 0.722，p = 0.007) 独立相关；腰围与 HSI（r = 0.492，p < 0.001）；FLI 测量腰围（r = 0.700，p < 0.001）、HDL 胆固醇（r = 0.719，p < 0.001）和 LDL 胆固醇（r = 0.712，p < 0.001）。

结论

血糖控制是与成人 T1D 患者 MASLD 相关的主要因素，也与超重和肥胖无关。预防和治疗 T1D 中的 MASLD 可能还需要以严格血糖控制为重点的适当治疗策略。