Clinically significant chronic liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Morling, Joanne R. and Fallowfield, Jonathan A. and Guha, Indra N. and Williamson, Rachel M. and Glancy, Stephen and Strachan, Mark W.J. and Price, Jackie F. (2015) Clinically significant chronic liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. QJM: An International Journal of Medicine . ISSN 1460-2725

[img]
Preview
PDF - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Available under Licence Creative Commons Attribution.
Download (846kB) | Preview

Abstract

Background: Type 2 diabetes is an independent risk factor for chronic liver disease, however disease burden estimates and knowledge of prognostic indicators are lacking in community populations.

Aims: To describe the prevalence and incidence of clinically significant chronic liver disease amongst community-based older people with Type 2 diabetes and to determine risk factors which might assist in discriminating patients with unknown prevalent or incident disease.

Design: Prospective cohort study.

Methods: Nine hundred and thirty-nine participants in the Edinburgh Type 2 Diabetes Study underwent investigation including liver ultrasound and non-invasive measures of non-alcoholic steatohepatitis (NASH), hepatic fibrosis and systemic inflammation. Over 6-years, cases of cirrhosis and hepatocellular carcinoma were collated from multiple sources.

Results: Eight patients had known prevalent disease with 13 further unknown cases identified (prevalence 2.2%) and 15 incident cases (IR 2.9/1000 person-years). Higher levels of systemic inflammation, NASH and hepatic fibrosis markers were associated with both unknown prevalent and incident clinically significant chronic liver disease (all P < 0.001).

Conclusions: Our study investigations increased the known prevalence of clinically significant chronic liver disease by over 150%, confirming the suspicion of a large burden of undiagnosed disease. The disease incidence rate was lower than anticipated but still much higher than the general population rate. The ability to identify patients both with and at risk of developing clinically significant chronic liver disease allows for early intervention and clinical monitoring strategies. Ongoing work, with longer follow-up, including analysis of rates of liver function decline, will be used to define optimal risk prediction tools.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced PDF of an article accepted for publication in QJM: An International Journal of Medicine following peer review. The version of record J.R. Morling, J.A. Fallowfield, I.N. Guha, R.M. Williamson, M. Ali, S. Glancy, M.W.J. Strachan, J.F. Price. Clinically significant chronic liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study (2015) is available online at: http://dx.doi.org/10.1093/qjmed/hcv191.
Schools/Departments: University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
Identification Number: https://doi.org/10.1093/qjmed/hcv191
Depositing User: Morling, Joanne
Date Deposited: 02 Mar 2016 14:40
Last Modified: 13 Sep 2016 20:34
URI: http://eprints.nottingham.ac.uk/id/eprint/32085

Actions (Archive Staff Only)

Edit View Edit View