Factors associated with significant liver fibrosis in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease: a single-center retrospective study
5 affiliations
- 1Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University
- 2Nanjing Drum Tower Hospital
- 3Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University
- 4Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University
- 5Branch of National Clinical Research Centre for Metabolic Diseases
Abstract
Background/aims: To identify factors associated with significant liver fibrosis in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) and to inform clinical risk stratification.
Methods: We retrospectively included adults hospitalized in the Department of Endocrinology, Nanjing Drum Tower Hospital, from January 2018 to December 2025 who had T2DM, MASLD, and vibration-controlled transient elastography (VCTE). Significant fibrosis was defined as liver stiffness measurement ≥ 8 kPa. Missing data were handled by multiple imputation (five datasets). After multicollinearity assessment, variables were entered into a multivariable logistic regression model, with a sensitivity analysis substituting ALT for AST.
Results: Among 1355 patients, 584 (43.10%) had significant fibrosis. Age (OR = 1.036), CAP grade (S1: OR = 1.808; S2: OR = 2.597; S3: OR = 2.709), AST (OR = 1.025), GGT (OR = 1.006), and hyperuricemia (OR = 1.345) were positively associated with significant fibrosis. BMI was not independently associated (OR = 1.034, 95% CI 0.993–1.077). SGLT-2 inhibitor use was inversely associated (OR = 0.618), whereas glinide use was positively associated (OR = 2.524); these medication findings were exploratory because treatment timing relative to VCTE was unavailable. Diabetic macrovascular disease showed an inverse association (OR = 0.582) that should not be interpreted as protective. ALT remained positively associated in sensitivity analysis (OR = 1.014).
Conclusions: Age, CAP grade, transaminase levels, GGT, and hyperuricemia were associated with significant fibrosis in patients with T2DM and MASLD. Medication-related associations require prospective confirmation.
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BibTeX
@article{ding2026factors,
title = {{Factors associated with significant liver fibrosis in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease: a single-center retrospective study}},
author = {Yi Ding and Xuerong Ma and Yafei Luo and Zhuolin Zhou and Lintong Li and Zhijuan Ge and Cheng Ji},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.2005171},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.2005171/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Factors associated with significant liver fibrosis in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease: a single-center retrospective study
AU - Yi Ding
AU - Xuerong Ma
AU - Yafei Luo
AU - Zhuolin Zhou
AU - Lintong Li
AU - Zhijuan Ge
AU - Cheng Ji
PY - 2026
DA - 2026/11/03
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.2005171
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.2005171/full
AB - Background/aims: To identify factors associated with significant liver fibrosis in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) and to inform clinical risk stratification. Methods: We retrospectively included adults hospitalized in the Department of Endocrinology, Nanjing Drum Tower Hospital, from January 2018 to December 2025 who had T2DM, MASLD, and vibration-controlled transient elastography (VCTE). Significant fibrosis was defined as liver stiffness measurement ≥ 8 kPa. Missing data were handled by multiple imputation (five datasets). After multicollinearity assessment, variables were entered into a multivariable logistic regression model, with a sensitivity analysis substituting ALT for AST. Results: Among 1355 patients, 584 (43.10%) had significant fibrosis. Age (OR = 1.036), CAP grade (S1: OR = 1.808; S2: OR = 2.597; S3: OR = 2.709), AST (OR = 1.025), GGT (OR = 1.006), and hyperuricemia (OR = 1.345) were positively associated with significant fibrosis. BMI was not independently associated (OR = 1.034, 95% CI 0.993–1.077). SGLT-2 inhibitor use was inversely associated (OR = 0.618), whereas glinide use was positively associated (OR = 2.524); these medication findings were exploratory because treatment timing relative to VCTE was unavailable. Diabetic macrovascular disease showed an inverse association (OR = 0.582) that should not be interpreted as protective. ALT remained positively associated in sensitivity analysis (OR = 1.014). Conclusions: Age, CAP grade, transaminase levels, GGT, and hyperuricemia were associated with significant fibrosis in patients with T2DM and MASLD. Medication-related associations require prospective confirmation.
SN - 1664-2392
ER -