Original Article
Pancreas, Biliary Tract, and Liver
Inverse Association Between Fatty Liver at Baseline Ultrasonography and Remission of Type 2 Diabetes Over a 2-Year Follow-up Period

https://doi.org/10.1016/j.cgh.2020.06.032Get rights and content

Background & Aims

Improvement of fatty liver may be required for remission of type-2 diabetes. However, there is no longitudinal evidence on whether fatty liver reduces the chances for remission of type-2 diabetes. We investigated the association between fatty liver and remission of type-2 diabetes (the primary analysis), and also the association between improvement of fatty liver and remission of type-2 diabetes (the secondary analysis).

Methods

We collected data from 66961 people who underwent screening for type-2 diabetes from 2008 through 2016 at a single center in Japan. The primary analysis included 2567 patients with type-2 diabetes without chronic renal failure or a history of hemodialysis who underwent ultrasonography to detect fatty liver, all of whom had follow-up testing, including blood testing, for a median 24.5 months after the baseline ultrasonography. The secondary analysis included 1833 participants with fatty liver at baseline who underwent a second ultrasonography, and participants who had fatty liver at baseline but not at the second visit were considered to have had improvement of fatty liver. Remission of type-2 diabetes was defined as a fasting plasma glucose level below 126 mg/dL and an HbA1c level below 6.5% for more than 6 months without anti-diabetic drugs. Odds ratios (ORs) of remission of type-2 diabetes were estimated using logistic-regression models.

Results

A lower proportion of patients who had fatty liver detected by ultrasonography at baseline (8.7%, 167/1910) had remission of type-2 diabetes during the follow-up period than patients without fatty liver (13.1%, 86/657). Fatty liver at baseline was associated with a lower odds of remission of type-2 diabetes (multivariable-adjusted OR, 0.51; 95% CI, 0.37–0.72). A higher proportion of patients who had improvement of fatty liver had remission of type-2 diabetes (21.1%, 32/152) than patients with no improvement of fatty liver (7.7%, 129/1681). Improvement of fatty liver was associated with a higher odds of remission of type-2 diabetes (multivariable-adjusted OR, 3.08; 95% CI, 1.94–4.88).

Conclusions

Over a follow-up period of approximate 2 years, remission of type-2 diabetes was less common in people with fatty liver detected by ultrasonography, and improvement of fatty liver was independently associated with type-2 diabetes remission.

Section snippets

Source of Data

In this retrospective cohort study, we used secondary data collected during health examinations done at Keijinkai Maruyama Clinic, in Sapporo, Japan. We included people who underwent health examinations for T2D screening between January 1, 2008 and December 31, 2016. We included as participants people who met any of the following 3 criteria: (1) FPG ≥126 mg/dL, (2) HbA1c ≥6.5% (48 mmol/mol), or (3) having a prescription for any antidiabetic drugs. We excluded people who did not undergo

Participants

As shown in Figure 1, 66,961 individuals underwent health examinations between 2008 and 2016. Based on information in the questionnaires, the blood test results, and the ultrasonography results, 3549 people with T2D were selected for the study (Supplementary Table 1). Follow-up data from 2567 (72% of those 3549) were available for analysis. The participants with follow-up data were younger than those without follow-up data, and fewer of those with follow-up data were taking antihypertensive

Discussion

In this ultrasonography-based cohort study, FL was inversely associated with T2D remission: that is, patients with less fat in their liver were more likely to achieve T2D remission than were those with more fat in their liver. An inverse association was found between FL and T2D remission even when the analysis was restricted to data from those participants who were not taking antidiabetic drugs, and even when the analysis was restricted to data from participants who were neither overweight nor

Acknowledgments

The authors thank Keita Numata, Toru Yusa, and Megumi Sato of Keijinkai Maruyama Clinic. They also thank Joseph Green for suggestions and comments on earlier versions of this manuscript.

CRediT Authorship Contributions

Hajime Yamazaki (Conceptualization: Lead; Formal analysis: Lead; Methodology: Lead; Project administration: Lead; Writing – original draft: Lead; Writing – review & editing: Lead) Jui Wang (Methodology: Equal; Writing – review & editing: Equal) Shinichi Tauchi (Investigation: Equal; Writing – review & editing:

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    • Conflicts of interest The authors disclose no conflicts of interest.

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