1839-P: Glycemic Control Impacts Severity of Hepatic Fibrosis in NAFLD/NASH
ALEXOPOULOS, A-S; CROWLEY, M; WANG, Y; GUY, CD; HENAO, R; SEYMOUR, KA; SUDAN, R; PORTENIER, D; DIEHL, AM; ABDELMALEK, MF; COVIELLO, AD
Published in: Diabetes
T2DM increases risk for advanced fibrosis in NAFLD, however little is known about the impact of glycemic control on fibrosis severity.Objective: To assess whether glycemic control is associated with severity of fibrosis in NAFLD.Methods: We utilized the Duke NAFLD Clinical Database to examine the association between HbA1c and fibrosis in patients with biopsy (Bx)-proven NAFLD (n=941). A generalized linear regression model was used (adjusted for age, gender, race, BMI, HLD, eGFR) to assess the association of mean HbA1c (1 year pre- to 90d post-Bx) and fibrosis severity (stage 3-4=advanced vs. 0-2=mild). Patients with ≥3 HbA1c values (n=335) were examined by group-based trajectory analysis using HbA1c over 5 yrs pre- to 90d post-Bx.Results: Every 1% increase in mean HbA1c was associated with 20% higher odds of advanced fibrosis (OR 1.20, 95%CI 1.02, 1.39 p=0.02). Group-based trajectory analysis identified three glycemic patterns - good, moderate and poor (groups 1,2,3, respectively); proportion of advanced fibrosis increased with worse glycemic control. Group 2 had higher odds of advanced fibrosis than group 1 (OR 4.46, 95%CI 2.29,8.70, p<0.01). Group 3 estimates were limited by small sample size (OR vs. group 1: 2.55, 95% CI 0.87,7.44, p<0.01).Conclusion: Glycemic control preceding Bx impacts severity of liver fibrosis. We are currently analyzing 65 patients with paired Bx to assess impact of HbA1c trends on change in fibrosis severity.
