Correlated factors and prognostic importance of reduction in liver stiffness measurement in individuals with type 2 diabetes and MASLD.

BACKGROUND AND AIM: Reduction in liver fibrosis, as assessed by liver stiffness measurement (LSM) on serial vibration-controlled transient elastography (VCTE) examinations, may have beneficial effects on development of liver-related and cardiovascular outcomes in individuals with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS AND RESULTS: A prospective cohort of 288 individuals with type 2 diabetes and MASLD performed 2 VCTE exams at least two years apart, and significant LSM reduction was defined as >20 % decrease. Logistic regression assessed the independent correlates of having LSM reduction and multivariable Cox analyses assessed associations between LSM reduction and liver-related and cardiovascular outcomes. Eighty-six individuals (30 %) had a reduction in LSM >20 %; its independent correlates were a lower aspartate aminotransferase (AST ≤20 U/L) and HbA1c (≤7 %) levels closest to the 2nd VCTE exam, the use of statins and having the wild CC genotype of the PNPLA3 gene. Over a median follow-up of 6 years, there were 22 liver-related and 28 cardiovascular events. Reduction in LSM was associated with a significant 78 % lower risk of liver events and 62 % lower cardiovascular risk.

CONCLUSIONS: Using statins and achieving good glycemic control are associated with higher chances of having liver fibrosis reduction, and serum AST reduction may be a biomarker of such improvement. Having LSM reduction on serial VCTE examinations is associated with lower risks of adverse cardiovascular and liver-related events and, if further confirmed, it might be a treatment goal in individuals with type 2 diabetes and MASLD.