LIVER DYSFUNCTION IN DIABETICS: RECOGNIZING AND MANAGING NAFLD IN GENERAL PRACTICE

Abstract

Non-alcoholic fatty liver disease (NAFLD) is newly defined as metabolic dysfunction–associated steatotic liver disease (MASLD) and has been revealed as a common and critical complication of type 2 diabetes mellitus (T2DM). The objective of this study was to assess the magnitude of NAFLD among patients with T2DM who were seen at the endocrinology and general practice clinics at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from January 2024 to June 2025. This cross-sectional analytical research design study included 350 adult T2DM patients, calculated based on assumed 70% prevalence of NAFLD, 95% confidence and 5% margin of error. Demographic, anthropometric, biochemical & clinical parameters were evaluated in the study participants. All patients had Fibrosis-4 (FIB-4) scores calculated and those with indeterminate or high-risk scores went on to vibration-controlled transient elastography (VCTE). SPSS 28.0 was used for data analysis, and independent predictors of fibrosis presence were identified through logistic regression. NAFLD was observed in 68.3% of patients (high-risk: 14%, indeterminate: 25.1%). Factors significantly associated with fibrosis risk included age, duration of diabetes, BMI, poor glycemic control (HbA1c ≥8%), and dyslipidemia (higher triglycerides and lower HDL-C levels). Intermediate or high fibrosis risk was independently predicted by age ≥50 years, HbA1c ≥8, obesity (BMI ≥30 kg/m²), diabetes duration ≥10 years, and triglycerides ≥150 mg/dL, as confirmed by logistic regression. In conclusion, these findings emphasize that NAFLD represents an important source of morbidity amongst patients with diabetes, and that non-invasive fibrosis assessment tools can be used in primary and specialty care to assess the risk of liver-related morbidity.