Hepatic steatosis and diabetic retinopathy in individuals with type 1 diabetes: a cross-sectional study using liver elastography

Background Metabolic dysfunction associated steatotic liver disease (MASLD) is increasingly recognized in individuals with type 1 diabetes (T1D). However, its relationship with diabetic retinopathy (DR) remains poorly characterized. We evaluated the association between hepatic steatosis and DR severity in adults with T1D. Methods We conducted a cross-sectional study including 70 adults with T1D who underwent liver elastography using FibroScan ® . Hepatic steatosis was assessed by the controlled attenuation parameter (CAP), and DR was classified according to the Early Treatment Diabetic Retinopathy Study scale. Ordinal logistic regression models were used to evaluate the association between DR stage and CAP categories. Results Median age was 66.5 years (IQR: 55–73), median diabetes duration was 29.0 years (IQR: 18–42), and 64.3% of participants were women. Overall, 24.3% had evidence of hepatic steatosis. In unadjusted analysis, proliferative DR was associated with higher CAP categories (OR: 6.07; 95% CI: 1.66–22.25; p = 0.006). This association remained significant after adjustment for age, sex, alcohol intake, waist circumference, diabetes duration, and HbA1c (OR: 14.12; 95% CI: 1.80–110.70; p = 0.012). Waist circumference and alcohol intake were also independently associated with higher CAP categories. The association was consistent in sensitivity analyses. Conclusions Proliferative DR was independently associated with greater hepatic steatosis severity assessed by CAP in adults with T1D. These findings support a potential link between hepatic involvement and advanced microvascular disease in T1D.