Prevalence and Clinical Profile of Fatty Liver Disease among Patients with Type 2 Diabetes Mellitus: A Retrospective Hospital-Based Study

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease is common among patients with type 2 diabetes mellitus and may progress to steatohepatitis, advanced fibrosis, cirrhosis and hepatocellular carcinoma. However, the condition frequently remains unrecognised in routine clinical practice. Objectives: To determine the prevalence of fatty liver disease among patients with type 2 diabetes mellitus and describe its demographic, clinical, biochemical and imaging profile. Methods: A hospital-based retrospective observational study was conducted among 389 adults with type 2 diabetes mellitus and available abdominal imaging records. Demographic characteristics, duration of diabetes, body mass index, comorbidities, glycaemic parameters, lipid profile, liver-function parameters and imaging findings were extracted from medical records. Fibrosis risk was assessed using the fibrosis-4 index wherever the required variables were available. Factors associated with fatty liver disease were evaluated using appropriate univariable tests and multivariable binary logistic regression. A p-value <0.05 was considered statistically significant. Results: Fatty liver disease was identified in 253 patients, corresponding to a prevalence of 65.0% (95% CI: 60.1–69.6%). Among affected patients, 50.6%, 35.2% and 14.2% had Grade I, II and III steatosis, respectively. Patients with fatty liver were older and had longer diabetes duration, higher body mass index, poorer glycaemic control, adverse lipid profiles, elevated aminotransferases and higher fibrosis-4 scores. On multivariable analysis, obesity (adjusted OR: 3.15), HbA1c ≥9% (adjusted OR: 2.12), elevated alanine aminotransferase (adjusted OR: 2.01), hypertriglyceridaemia (adjusted OR: 1.86), diabetes duration ≥10 years (adjusted OR: 1.72), dyslipidaemia (adjusted OR: 1.67) and age ≥60 years (adjusted OR: 1.62) were independently associated with fatty liver disease. Conclusion: Fatty liver disease affected approximately two-thirds of patients with type 2 diabetes mellitus and was strongly associated with obesity and adverse metabolic characteristics. Routine assessment of hepatic steatosis and fibrosis risk should be considered, particularly among patients with obesity, longstanding diabetes or poor metabolic control.

Keywords: Fatty liver disease; MASLD; type 2 diabetes mellitus; hepatic steatosis; obesity; fibrosis-4 index; prevalence.