Advanced Liver Fibrosis Negatively Impacts Quality of Life in T2D

Advanced fibrosis and obesity significantly, negatively impacted health-related quality of life (HRQL) in individuals with steatotic liver disease and type 2 diabetes (T2D) treated in primary care, according to new data.¹

Individuals with T2D experience a high prevalence of SLD, particularly metabolic dysfunction-associated SLD (MASLD), affecting HRQL due to overlapping factors and liver-related comorbidities, including fibrosis.

“This has important implications for the consideration of SLD/MASLD and AF in the routine assessment of people with T2D in disease management programs,” wrote the investigative teams, led by Jörn M. Schattenberg, MD, department of Internal Medicine II, University Medical Centre Saarland.

Along the disease course of MASLD, the disease can progress to metabolic dysfunction-associated steatohepatitis (MASH), increasing scarring of liver tissue and advancing to liver fibrosis, including AF.² Non-invasive tests, including vibration-controlled transient elastography (VCTE), have been developed to identify patients with MASLD who require intensive care, but few studies are available on its use in primary care settings.³

The EQ-5D-3L, an HRQL-related questionnaire, estimates a patient’s functioning and well-being across 5 dimensions and perception of their health status over three response levels. It has been validated for T2D and SLD/MASLD, with higher disease stages typically reporting lower HRQL⁴. However, the independent effect size of the liver phenotype has not been established in patients with T2D, despite the prevalence of SLD and AF in this population.¹

For this study, Schattenberg and colleagues evaluated the influence of AF on HQRL in a population with T2D. A total of 149 patients with T2D, treated at a primary care provider with a German disease management program (BMP), met the criteria for inclusion in the final analysis. Hepatic steatosis and AF were non-invasively assessed using VTCE, while the EQ-5D-3L questionnaire evaluated the HRQL.

Independent predictions of impaired HRQL were categorized through univariable and multivariable linear regression models. Among the study population, the prevalence of SLD was 77.9% (n = 116), with the majority (70.7%; n = 104) having MASLD. AF was identified in 19.5% (n = 24) of patients.

Upon analysis, individuals with T2D and AF demonstrated an overall lower HRQL, compared with those without AF (P <.001). In multivariable linear regression analysis, obesity (β, –0.247; 95% CI, –0.419 to –0.077) and AF (β, –0.222; 95% CI, –0.383 to –0.051) were the only independent predictors of a poor HRQL. However, T2D-related comorbidities, including cardiovascular disease (CVD), retinopathy, polyneuropathy, and diabetic foot syndrome, no longer predicted an impaired HRQL after the multivariable adjustment.

In their summary, Schattenberg and colleagues noted that while the study did not evaluate the number of comorbidities specifically, the strong effect of AF on HRQL could be an expression of these overlapping factors, particularly given the context of T2D.

“Implementing a routine assessment of liver fibrosis in people with T2D may aid in identifying those with an overall higher disease burden and a lower HRQL,” they wrote. “...Awareness of liver health and specific interventions may improve patient-reported and liver-related outcomes in people with T2D.”

References

1. _{Michel M, Funuyet-Salas J, Doll M, et al. Impairment of health-related quality of life among people with type 2 diabetes and advanced liver fibrosis. Sci Rep. 2024;14(1):21650. Published 2024 Sep 17. doi:10.1038/s41598-024-72105-8}
2. _{Diehl AM, Day C. Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis. N Engl J Med. 2017;377(21):2063-2072. doi:10.1056/NEJMra1503519}
3. _{Tapper EB, Loomba R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD. Nat Rev Gastroenterol Hepatol. 2018;15(5):274-282. doi:10.1038/nrgastro.2018.10}
4. _{Younossi ZM, Stepanova M, Anstee QM, et al. Reduced Patient-Reported Outcome Scores Associate With Level of Fibrosis in Patients With Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol. 2019;17(12):2552-2560.e10. doi:10.1016/j.cgh.2019.02.024}