Development of Diabetes Mellitus in MAFLD- Decompensated Cirrhotic are at Most Risk

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called NAFLD, is the leading cause of chronic liver disease (CLD) globally. It occurs when excess fat builds up in the liver and is closely linked to metabolic conditions like obesity, type 2 diabetes, and high blood pressure. MASLD encompasses a continuum of conditions ranging from simple fatty liver to severe, progressive liver damage. Simple Steatosis (Fatty Liver) is excess fat accumulation in the liver but there is little to no inflammation or damage. MASH (Metabolic Dysfunction-Associated Steatohepatitis) is more severe form where fat accumulation is accompanied by liver inflammation and cell damage. Fibrosis is ongoing inflammation leads to the buildup of scar tissue in the liver, graded on a scale from F1 (mild) to F4 (cirrhosis). The aim is to estimate prevalence of development of Diabetes Mellitus in Metabolic dysfunction associated steatotic liver disease patients at tertiary care center of Northern India. Material and Methods: This study was conducted at Medical Gastroenterology Department at PGIMS, Rohtak. It was a prospective study done over six years, from 01.04.2020 to 31.03.2026, during which 300 confirmed Metabolic dysfunction associated steatotic liver disease (MAFLD) were investigated for development of diabetes mellitus. For better understanding 100 patients each of F0-F1 fibrosis, F2-F3 fibrosis and F4 (cirrhotic) patient on were enrolled. All these 300 patients were followed up for at least three to five years after being diagnosed of MAFLD for development of diabetes mellitus. The three-to-five-year time period was helpful in determining the late effect of MAFLD in causing pre-diabetic and diabetic stage. Out of total pool of 300 MAFLD patients, 142 (47.33%) were male and 158 (52.67%) were female. The age group was between 20 yrs- 78 yrs with mean age of 45 years. Patient were labelled diabetic, if blood sugar fasting and post prandial were more than 126mg% and 200 mg% respectively or HbA1C was more than 6.5. Pre-diabetic was defined as blood sugar fasting and post prandial was 100-126mg% and 140-200 mg% respectively or HbA1C was between 5.7- 6.5. All MAFLD patients were diagnosed after ruling out viral infections including HBV, HCV, HAV, HEV, HIV, normal autoimmune & Wilson profile, ultrasonogram abdomen showed fatty liver or cirrhotic changes, with transaminitis on liver function test and fibrosis or cirrhosis was graded on fibroscan. The written informed consent was taken before enrollment in the study. Results: Our department is Model treatment Center (MTC) under National Program on Non-communicable diseases, of which Fatty liver is integral part. Our center is one of the high flow centers in India. On daily basis, 3-4 new and 25 follow up patients of MAFLD/MASH or cirrhosis come for consultation and till date 2000 patients have been enrolled in last thirteen years. Out of total pool of 300 MASH related cirrhotic patients, 100 patients each of F0-F1 fibrosis, F2-F3 fibrosis and F4 (cirrhosis) were enrolled. The new onset diabetes mellitus was seen in 18 patients (6%) with F0-F1 fibrosis, 36 (12%) of F2-F3 fibrosis and 66 (22%) of cirrhotic patients. In cirrhotic also, majority were decompensated. On Pre-diabetic analysis, 10 patients (3.33%) were seen in F0-F1 fibrosis group, 19 (6.33%) in F2-F3 fibrosis and 30 (10%) in cirrhotic patients, predominantly in decompensated stage. Conclusion: MAFLD and MASH, especially in cirrhotic stage have high risk of developing diabetes mellitus, hence life-long surveillance is required for the same. The development of DM in these cases is detrimental as fastens the rate of progression of fibrosis as well as cirrhosis. Hence, strict control of blood sugar levels, along with regular treatment of cirrhosis and its complications is mandatory.

Keywords: Diabetes Mellitus, HbA1C level, Fibrosis, Cirrhosis, MAFLD, MASH.