Fibroscan of Liver in Type 2 Diabetes Mellitus and Its Correlation with Risk Factors

Introduction: Non-alcoholic fatty liver disease (NAFLD) is regarded as the hepatic manifestation of metabolic syndrome. Insulin resistance is regarded as central to the development of NAFLD. Type 2 Diabetes Mellitus (DM) is an important cause of NAFLD. The pathology in NAFLD ranges from hepatic steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis and primary liver cancer. Diagnosis of NAFLD requires demonstration of increased liver fat in the absence of hazardous levels of alcohol consumption. Liver biopsy is the gold standard for diagnosis of NAFLD but it is fraught with various difficulties and is a risky procedure. Fibroscan (?Abbott) or transient elastography is a non-invasive tool which measures the hepatic stiffness. Objective: To estimate the degree of hepatic stiffness due to NAFLD and to identify the factors affecting it. Patients: 50 patients of newly diagnosed Type 2 diabetes mellitus without a history of chronic hepatitis or alcohol intake were included in the study. Results: In our study, 40% of the patients were obese with 46% of the total patients having an elevated AST, 66% having an elevated ALT and 18% having an elevated alkaline phosphatase. Dyslipidemia was very common with 14% of total patients having a high cholesterol, 36% having elevated triglycerides, 64% having a low HDL with none with an elevated LDL. 50% of patients had steatosis on ultrasound. On comparing liver stiffness, a significantly high hepatic stiffness (>7.9 kPa) was found in 34% of patients with severe fibrosis (≥12 kPa) in 10% of patients. Multivariate analysis showed significant positive correlation of fibroscan value with total cholesterol and ALT levels and there was a significant negative correlation with AST levels and serum HDL levels. Conclusion: Fibroscan may be helpful in diagnosing and guiding treatment of NAFLD. Larger studies to evaluate its efficacy in determining prognosis of NAFLD are warranted.