MASLD in adults with type 1 diabetes and type 2 diabetes undergoing vibration‐controlled transient elastography

Background: There is limited evidence on the prevalence of, and factors contributing to, metabolic dysfunction-associated steatotic liver disease (MASLD) among individuals with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Methods: We consecutively enrolled 1304 adult individuals with T1DM (n = 237) or T2DM (n = 1067) who underwent vibration-controlled transient elastography (VCTE) with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) assessment. MASLD was defined as a CAP ≥ 248 dB/m in the presence of diabetes. Significant and advanced liver fibrosis were defined as LSM ≥ 8 kPa and ≥ 10 kPa, respectively. Results: Compared to adult patients with T1DM, those with T2DM had higher prevalence rates of MASLD (65.7% vs. 38.4%, p < 0.001), significant liver fibrosis (18.6% vs. 5.1%, p < 0.001) and advanced fibrosis (9.8% vs. 3.8%, p = 0.003). Adiposity measures (higher BMI and larger waist circumference) and increased plasma triglyceride levels were the strongest predictors of MASLD in both patient groups. After a propensity score matching analysis for age, sex and BMI, patients with T2DM maintained a higher prevalence of MASLD (65.7% vs. 52.6%, p = 0.033) than those with T1DM, but they had similar rates of significant and advanced liver fibrosis. Conclusions: Patients with T2DM have higher prevalence rates of MASLD, significant and advanced hepatic fibrosis, as detected by VCTE, compared to adult patients with T1DM. Biomarkers of insulin resistance (such as higher BMI, larger waist circumference and higher plasma triglycerides) are equally important in explaining the presence of MASLD in patients with T1DM and T2DM.