Diabetes Mellitus, Insulin, Sulfonylurea and Advanced Fibrosis in Non-Alcoholic Fatty Liver DiseaseGeorge Boon-Bee Goh1, Mangesh R Pagadala1, Jaividhya Dasarathy3, Aynur Unalp-Arida7, Ruth Sargent1, Carol Hawkins2, Achuthan Sourianarayanane1, Amer Khiyami5, Lisa Yerian4, Rish K Pai4, Srinivasan Dasarathy1,6 and Arthur J McCullough1,6*
- *Corresponding Author:
- Arthur J McCullough
Department of Gastroenterology
Cleveland Clinic Foundation 9500 Euclid Avenue/A30
Cleveland, OH 44195, USA
E-mail: [email protected]
Received date: June 27, 2014; Accepted date: July 26, 2014; Published date: August 03, 2014
Citation: Goh GBB, Pagadala MR, Dasarathy J, Unalp-Arida A, Sargent R, et al. (2014) Diabetes Mellitus, Insulin, Sulfonylurea and Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease. J Diabetes Metab 5:410 doi: 10.4172/2155-6156.1000410
Copyright: © 2014 Goh GBB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background & aims: Diabetes mellitus is a risk factor for advanced fibrosis in non-alcoholic fatty liver disease. However, not all non-alcoholic fatty liver disease patients with diabetes develop advanced fibrosis. We hypothesised that prescription medications used by these patients influence the development of advanced fibrosis. We investigated the association of commonly used medications and advanced fibrosis in non-alcoholic fatty liver disease patients with diabetes.
Methods: Clinical information including demographics, medical history, medication history, biochemical and histologic variables were ascertained in 459 patients with biopsy proven non-alcoholic fatty liver disease. We compared characteristics of patients with and without diabetes and explored potential associations between classes of drugs as risk factors and advanced fibrosis among the diabetic patients with NAFLD.
Results: Presence of diabetes was an independent risk factor for advanced fibrosis. In diabetic patients, age (OR 1.09; 95%CI 1.04-1.15, p=0.000) and grade of ballooning (OR 5.59; 95%CI 2.69-11.61, p=0.000) had a positive relationship with advanced fibrosis. The use of insulin (OR 4.95; 95%CI 1.65-14.88, p=0.004) and sulfonylurea (OR 5.07; 95%CI 1.87-13.75, p=0.001) were positively associated while statin use (OR 0.31; 95%CI 0.12-0.78, p=0.013) was negatively associated with advanced fibrosis. Conclusion: Among non-alcoholic fatty liver disease patients with diabetes, the prevalence of advanced fibrosis was higher in patients treated with insulin and sulfonylurea, but lower in patients on statins. These findings provide support for a greater role of statin use in non-alcoholic fatty liver disease patients with diabetes while limiting the use of insulin and sulfonylurea.