Long-Term glycemic control and the risk of liver stiffness progression and liver-related events in MASLD

Abstract

Background & Aims: the long-term impact of type 2 diabetes (T2D) status and long-term glycemic control on disease progression and clinical outcomes in metabolic dysfunction–associated steatotic liver disease (MASLD) remains unclear. The study sought to assess the association of diabetes status and long-term glycemic control with liver stiffness progression or regression, and liver-related events (LREs) in MASLD.

Methods: we analyzed patients with MASLD from the VCTE-Prognosis cohort who underwent serial vibration-controlled transient elastography (VCTE) assessments and hemoglobin A1c (HbA1c) measurements. Long-term glycemic control was evaluated using the time-weighted average (TWA) HbA1c, which reflects both the magnitude and duration of glycemia. Patients were categorized as non-T2D, well-controlled T2D (TWA HbA1c<7%), or poorly controlled T2D (TWA HbA1c ≥7%). Liver stiffness progression, regression, and LREs were examined using Kaplan-Meier analyses and Cox proportional hazards models.

Results: of 7543 patients with MASLD, 4090 had T2D (2045 well controlled, 2045 poorly controlled) and 3453 did not have T2D. Over a median follow-up of 4.1 years, patients with T2D had a higher risk of liver stiffness progression (hazard ratio [HR], 1.501, 95% confidence interval [CI]. 1.148–1.962; P = .003) and LREs (HR, 2.030; 95% CI, 1.241–3.320; P = .005), but not liver stiffness regression, compared with non-T2D patients. Among patients with T2D, poor glycemic control was associated with a higher risk of liver stiffness progression compared with good glycemic control (HR, 1.524; 95% CI, 1.182–1.965; P = .001). No differences were observed for liver stiffness regression (P = .957) or LREs (P = .625) with glycemic control. Findings were consistent across sensitivity analyses.

Conclusions: T2D was independently associated with a higher risk of liver stiffness progression and LREs in MASLD. Good glycemic control was associated with slower liver stiffness progression, but not regression or LREs.

More information

Identifiers

ORCID for Christopher D. Byrne: orcid.org/0000-0001-6322-7753

Catalogue record

Export record

Altmetrics