Prevalence of NAFLD and Advanced Fibrosis in Patients With Type 1 Diabetes

Nonalcoholic Fatty Liver, Nonalcoholic Steatohepatitis, Fibrosis, Liver, Type 1 Diabetes, Cirrhosis, Liver

Nonalcoholic fatty liver disease (NAFLD), Nonalcoholic steatohepatitis (NASH), Type 1 Diabetes, Screening, Advanced fibrosis

The aim of this study is to assess the prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with type 1 diabetes receiving care at Joslin clinic using noninvasive imaging and serum-based methods with the goal of identifying high-risk patients with advanced fibrosis who should be prioritized for specialty referral

This is a prospective cohort, single-center, single-arm study screening adult subjects with type 1 diabetes from the Joslin Diabetes Center outpatient clinic mainly through physician referrals for NAFLD and advanced fibrosis. Subjects will undergo a one-time screening which will last for about 30 minutes. The following procedures will be conducted during the study visit: 1. Blood draw for metabolic measurements (HbA1c, lipid panel, ALT, AST, serum albumin, complete blood count-CBC) 2. FibroScan Measurements (LSM and CAP) 3. Anthropometric measurements (weight, height, BMI calculation, waist, and hip circumference) 4. Systolic and diastolic blood pressure Blood Draw: Samples of blood taken during the trial for laboratory testing will include the following metabolic measurements: AST, ALT, Platelets, percentage A1C, and lipid parameters (TC, LDL, HDL, TG). Fibroscan: Vibration controlled transient elastography (VCTE) or FibroScan® (EchoSens, Paris, France) is a simple aid to diagnose adult patients with chronic liver diseases. FibroScan provides a fast and reliable alternative to hepatic needle biopsy. In this 5-7 minute test, the investigator induces a mild amplitude shear wave into liver tissue from a small mechanical vibrator at the end of the FibroScan probe. VCTE evaluates a representative volume of the liver that is 100-fold greater than needle biopsy and the liver stiffness measurement (LSM) is expressed in kilopascals (kPa) with values \>9.8 kPa being consistent with the presence of advanced fibrosis/cirrhosis. Typically, 10 successful VCTE measurements with a median interquartile range/median ration of less than 30% are needed to have a reliable LSM. FIB-4 Index: This is a noninvasive surrogate biomarker of advanced fibrosis that is calculated using the following formula: FIB-4 = Age (years)×AST (U/L)/\[PLT(109/L)×√ALT(U/L)\] (Sterling, Lissen et al. 2006) FIB-4\>2.67 is consistent with the presence of advanced fibrosis with 80% PPV. NAFLD Fibrosis Score (NFS): This is a noninvasive surrogate biomarker of advanced fibrosis that is calculated using the following formula: NFS= -1.675 + 0.037 - age (years) + 0.094 - BMI (kg/m2) + 1.13 × IFG/diabetes (yes = 1, no = 0) + 0.99 × AST/ALT ratio - 0.013 × platelet count (×109/l) - 0.66 × albumin (g/dl). NFS\>0.676 is consistent with the presence of advanced fibrosis Anthropometric measurements: These include weight, height, BMI calculation, waist, and hip measurements. Measurements will be done using standardized anthropometric techniques. Follow up may be required for High-risk patients with advanced fibrosis. If patient consents, referring or treating physicians will be notified and provided with fibroscan results for possible referral to hepatologists for further evaluation and intervention.

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