Liver fibrosis and diabetic peripheral neuropathy in individuals with type 2 diabetes mellitus: an observational, cross-sectional study

Abstract

Aim: To evaluate the association between liver fibrosis, investigated by non-invasive fibrosis scores and measurement of stiffness, and diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM).

Methods: We conducted a cross-sectional, retrospective study including individuals with T2DM and hepatic steatosis who underwent a DPN examination. Liver fibrosis risk was estimated using the fibrosis-4 score (FIB-4), non-alcoholic fatty liver disease fibrosis score (NFS), aspartate transaminase (AST)/alanine transaminase (ALT) ratio, and the AST to platelet ratio index. Fibrosis was investigated using the vibration-controlled transient elastography (Fibroscan®) in a subgroup of patients. Liver stiffness measurement (LSM) ≥ 7.0 kPa defined significant fibrosis.

Results: Eighty-six T2DM subjects (mean age 59.22 ± 13.18 years; 69.8% male; DPN prevalence 43%) were included. Higher risk scores of liver fibrosis (FIB-4 and AST/ALT) in subjects with DPN compared to those without DPN were detected (FIB-4: 1.23 ± 0.66 vs. 1.63 ± 0.85; P = 0.018; AST/ALT: 0.89 ± 0.23 vs. 1.11 ± 0.61; P = 0.026). The DPN group showed higher LSM values, and the Michigan Diabetic Neuropathy Score was directly related to LSM (Rho: 0.304, P = 0.026). Moreover, a higher prevalence of alteration in vibration or reflexes was observed in subjects with LSM ≥ 7 kPa (P = 0.025 and P = 0.042, respectively). Finally, the evaluation of vibration or reflexes in individuals at high risk of liver fibrosis at FIB-4 and AST/ALT was associated with DPN (FIB-4 + abnormal vibration: P = 0.047; FIB-4 + abnormal reflexes: P = 0.013; AST/ALT + abnormal vibration: P < 0.001; AST/ALT + abnormal reflexes: P < 0.001).

Conclusion: The evaluation of vibration or reflexes would be useful in identifying DPN in T2DM with Metabolic Dysfunction-Associated Steatotic Liver Disease at high risk of fibrotic evolution.

Keywords

Metabolic dysfunction-associated steatotic liver disease / hepatic fibrosis / diabetes mellitus / diabetic peripheral neuropathy

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