Association of liver elastography measurements with poor glycaemic control in elderly patients with type 2 diabetes

The relationship between liver health and glycaemic control in elderly patients with diabetes remains poorly understood. In this study, the value of liver elastography in identifying associations with poor glycaemic control among elderly patients with type 2 diabetes mellitus was investigated.

In total, 90 elderly patients (aged ≥ 60 years) with type 2 diabetes mellitus were enrolled in this prospective observational study. All participants underwent liver elastography using FibroScan® and continuous glucose monitoring (CGM). Liver stiffness measurements (LSMs) and the controlled attenuation parameter (CAP) were obtained. Glycaemic control was assessed through multiple parameters, including the time in range (TIR), time above range (TAR), glycaemic variability, and mean glucose levels. Poor glycaemic control was defined as a TIR < 70%. The mean age of the participants was 64.0 ± 10.5 years, with 65.6% being female. The mean liver stiffness was 6.1 ± 7.8 kPa, and the mean CAP was 266.0 ± 54.7 dB/m.

Patients with higher liver stiffness (>8.0 kPa) had a significantly lower TIR (68.7% versus 83.5%, p<0.001) than those with normal liver stiffness (<5.5 kPa). LSMs were strongly negatively correlated with the TIR (r = -0.42, p < 0.001) and positively correlated with the mean glucose level (r = 0.38, p < 0.001). Multivariate analysis revealed that increased liver stiffness was independently associated with poor glycaemic control (adjusted OR = 1.28, 95% CI: 1.14-1.44; p < 0.001).

ROC analysis revealed an exploratory LSM cut-off value of 6.8 kPa for association with poor glycaemic control (AUC = 0.76; sensitivity = 71.2%; specificity = 78.9%). LSMs via transient elastography are independently associated with poor glycaemic control in elderly patients with type 2 diabetes. An LSM threshold of 6.8 kPa may help identify patients who are more likely to present with poor glycaemic control.