Fatty Liver Disease in the Diabetic Population: A Cross-Sectional Study From Pakistan

Introduction Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disorder, particularly among patients with type 2 diabetes mellitus (T2DM). The association between NAFLD and diabetes is bidirectional, with NAFLD increasing the risk of diabetes and vice versa. Therefore, this study aimed to determine the prevalence of NAFLD in diabetic individuals and evaluate the impact of metabolic and cardiovascular factors, along with the role of anti-diabetic medications in NAFLD progression. Study methodology After the approval from the United Medical and Dental College - Institutional Review Board (UMDC-IRB) (UMDC-IRB-2022/A-1713), this cross-sectional study was carried out at the Department of Gastroenterology, United Medical and Dental College from January 2023 to December 2023. A total of 250 diabetic patients aged between 30 and 65 years were enrolled in the study. Patients with a history of alcohol consumption, viral hepatitis, autoimmune hepatitis, and chronic kidney disease (CKD) stage 4 or higher were excluded from the study. Data collection involved demographic profiling, laboratory investigations (HbA1c, lipid profile, and liver function tests), and imaging assessment using an abdominal ultrasound to determine the presence or absence of fatty liver. Statistical analysis was conducted using SPSS version 25.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY), with p ≤ 0.05 considered statistically significant. Results Among the 250 diabetic patients, 178 (71.2%) were diagnosed with NAFLD. Higher BMI (p ≤ 0.001), poor glycemic control (HbA1c > 8.5%) (p ≤ 0.001), and dyslipidemia (p ≤ 0.001) were significantly associated with the presence of NAFLD in the diabetic population. Hypertension (p ≤ 0.001) and coronary artery disease (p = 0.031) were also the factors more prevalent in the NAFLD group. Patients on glucagon-like peptide 1 (GLP-1) receptor agonists (p = 0.018) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (p = 0.042) had a significantly lower prevalence of NAFLD. Conclusion NAFLD is highly prevalent among diabetic individuals, with significant cardiovascular implications. Routine screening and targeted interventions are essential to mitigate liver-related complications in this high-risk population.