Zeroing in on Hepatic Steatosis Screening in Patients with Type 2 Diabetes Mellitus: A Retrospective Analysis of the Vicious Trifecta-Obesity, Nonalcoholic Fatty Liver Disease, and Diabetes

Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus commonly coexist and act synergistically to drive worse prognosis for each other. Insulin resistance, obesity, and metaflammation are some of the important underlying pathologies. Despite the overwhelming prevalence of NAFLD in type 2 diabetic patients, there exists neither a proper screening protocol nor any specific management guideline for the same. With our study, we focus on three major diseases: diabetes, obesity, and NAFLD. We established collinearity among hemoglobin A1C (HbA1c), body mass index (BMI), and liver stiffness [kilopascals (kPa)] using multivariate linear regression. We were able to express kPa as a weighted average of the other two variables. Moreover, using correlation plots, we calculated critical values for both HbA1c and BMI as 6.57 and 26, respectively, beyond which the risk of liver fibrosis is accentuated significantly. We used the same cutoff values in our data to veritably prove that patients had increasing severity and frequency of hepatic steatosis/fibrosis as they exceeded the critical limit. Patients with both BMI and HbA1c below the cutoff had predominantly no/mild steatosis, while patients with both values exceeding the cutoff had predominantly severe steatosis/fibrosis on ultrasonographic imaging. Patients who had either of the two variables above the said limit had steatosis severity somewhere in between the two groups, highlighting that even one uncontrolled variable would significantly worsen the prognosis.