Alanine Aminotransferase Elevation at Diagnosis of Youth‐Onset Type 2 Diabetes: Prevalence, Predictors, and One‐Year Outcomes

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) and Type 2 Diabetes (T2D) are components of insulin resistance, but the prevalence of MASLD at the diagnosis of youth-onset T2D is unknown. We aimed to describe the prevalence of alanine aminotransferase (ALT) elevation, a biomarker for MASLD, in youth-onset T2D at diagnosis and after one year and investigate factors associated with ALT elevation. METHODS: A single-centre retrospective cohort study was conducted of patients (age ≤ 21 years) diagnosed with T2D between 1/1/2010 and 31/12/2021, with ALT available at diagnosis. ALT elevation was defined as being greater than 1.5 times the upper range of normal based on patient sex. RESULTS: In the cohort (n = 438), 58% of patients had ALT elevation at T2D diagnosis. Hispanic patients had higher odds of ALT elevation than non-Hispanic Black patients (p < 0.001), and lower HbA1c at diagnosis was associated with higher odds of ALT elevation (p < 0.001). Among patients followed for one year (n = 141), the prevalence of ALT elevation decreased from 65% to 47%. ALT at diagnosis was not associated with a change in Haemoglobin A1C (HbA1c) from diagnosis to one year of follow-up, nor was HbA1c at diagnosis associated with a change in ALT. CONCLUSIONS: ALT elevation is common at T2D diagnosis in youth. HbA1c is negatively associated with ALT elevation at diagnosis, but ALT and HbA1c at diagnosis did not impact the change in the corresponding marker at one year. The prevalence of elevated ALT varies between groups, and analysis of disease course within subpopulations is pertinent.