Transient elastography in adults with diabetes or prediabetes: steatosis prevalence and change in controlled attenuation parameter during incretin therapy

Abstract Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in patients with diabetes, but data from Gulf Cooperation Council countries using vibration-controlled transient elastography are scarce. In this single-centre prospective study, 151 adults with diabetes/prediabetes in the United Arab Emirates referred for non-invasive liver assessment underwent elastography. Hepatic steatosis, defined by a controlled attenuation parameter (CAP) of at least 248 dB/m, was present in 60.3% (95% confidence interval 52.0 to 68.1); across thresholds in current use the estimate ranged from 67.5% to 29.8%. Liver stiffness suggestive of advanced fibrosis was present in 12.6% (7.7 to 19.0). In 46 patients prescribed semaglutide or tirzepatide in routine care, a repeat examination was performed a median of 22.9 weeks later. CAP fell by 26.9 dB/m (95% CI − 46.0 to − 7.8; P = 0.007), whereas liver stiffness did not change. The fall was larger in patients steatotic at baseline (− 43.5 dB/m) than in those below it (+ 4.3 dB/m). Weight fell by 9.6 kg and glycated haemoglobin by 0.55%. Follow-up CAP regressed on baseline gave a slope of 0.35, and a single-arm design cannot separate treatment from weight loss, regression to the mean, or measurement variability. . In conclusion, hepatic steatosis was common, and CAP reduced after incretin-based therapy