A prospective study on the prevalence of MASLD in people with type‐2 diabetes in the community. Cost effectiveness of screening strategies

Abstract

Background and AimsAs screening for the liver disease and risk‐stratification pathways are not established in patients with type‐2 diabetes mellitus (T2DM), we evaluated the diagnostic performance and the cost‐utility of different screening strategies for MASLD in the community.MethodsConsecutive patients with T2DM from primary care underwent screening for liver diseases, ultrasound, ELF score and transient elastography (TE). Five strategies were compared to the standard of care: ultrasound plus abnormal liver function tests (LFTs), Fibrosis score‐4 (FIB‐4), NAFLD fibrosis score, Enhanced liver fibrosis test (ELF) and TE. Standard of care was defined as abnormal LFTs prompting referral to hospital. A Markov model was built based on the fibrosis stage, defined by TE. We generated the cost per quality‐adjusted life year (QALY) gained and calculated the incremental cost‐effectiveness ratio (ICER) over a lifetime horizon.ResultsOf 300 patients, 287 were included: 64% (186) had MASLD and 10% (28) had other causes of liver disease. Patients with significant fibrosis, advanced fibrosis, and cirrhosis due to MASLD were 17% (50/287), 11% (31/287) and 3% (8/287), respectively. Among those with significant fibrosis classified by LSM≥8.1 kPa, false negatives were 54% from ELF and 38% from FIB‐4. On multivariate analysis, waist circumference, BMI, AST levels and education rank were independent predictors of significant and advanced fibrosis. All the screening strategies were associated with QALY gains, with TE (148.73 years) having the most substantial gains, followed by FIB‐4 (134.07 years), ELF (131.68 years) and NAFLD fibrosis score (121.25 years). In the cost‐utility analysis, ICER was £2480/QALY for TE, £2541.24/QALY for ELF and £2059.98/QALY for FIB‐4.ConclusionScreening for MASLD in the diabetic population in primary care is cost‐effective and should become part of a holistic assessment. However, traditional screening strategies, including FIB‐4 and ELF, underestimate the presence of significant liver disease in this setting.

Dysmetabolic comorbidities and non-alcoholic fatty liver disease: a stairway to metabolic dysfunction-associated steatotic liver disease

“…The predominant cardiovascular risk factor of MASLD is BMI > 23 kg/m 2 [17] . T2DM is an independent predictor of MASLD and its complications, especially if associated with tobacco consumption [50,51] . In this context, several classes of antidiabetic drugs have favorable effects on liver function [52] .…”

Association between the peripheral neutrophil-to-lymphocyte ratio and metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes

“…MASLD is widely recognized as the most prevalent chronic liver disease, which affects around 30% of the global population (2). The prevalence of MASLD in type 2 diabetes patients is approximately 65% (3). Additionally, previous researches have demonstrated that the prevalence of MASLD shows a remarkable sex disparity, with higher risk among men (4).…”

“…Increasing researches have demonstrated that MASLD is linked with multiple metabolic disorders, including insulin resistance, obesity and abnormal glucose metabolism (29). MASLD and type 2 diabetes frequently occur together (3). Therefore, our study was to explore the relation between peripheral NLR values and MASLD in Chinese type 2 diabetes patients.…”

Adipocytokines as Predictors of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Development in Type 2 Diabetes Mellitus Patients

“…T2DM patients represent an important target group for the detection of MASLD, which can even progress to liver fibrosis with the development of more severe comorbidities. In both conditions, a possible key factor could be the presence of insulin resistance (IR) and adipose tissue disorders that are linked to the pathophysiology of “metabolic dysfunction,” liver disease, and the development of cardiovascular and metabolic complications [ 7 ].…”