Author(s): Manchanayake J, Chitturi S, Nolan C, Farrell GC
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Abstract BACKGROUND AND AIMS: Despite strong associations between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D), it is unclear which patients need oral glucose tolerance testing (OGTT). Relationships between hyperglycemia, postprandial hyperinsulinemia and NAFLD severity also need clarification. METHODS: Among 111 consecutive NAFLD patients, 35 had established T2D; 70 of the remaining 76 underwent 75G OGTT with fasting, 60 and 120 min insulin. Hepatic fibrotic severity was estimated by NAFLD fibrosis score and evidence of cirrhosis. RESULTS: Twenty-four (33\%) showed abnormal glucose tolerance: seven T2D, 17 impaired glucose tolerance (IGT). NAFLD patients with newly diagnosed T2D or IGT were (mean) 9 years older and more likely female (54\% vs 30\%). Fasting hyperglycemia (5.6-6.9 mmol/L) had limited sensitivity (46\%) but high specificity (89\%) for identifying patients with IGT/T2D; positive and negative predictive values were 69\% and 76\%. Postprandial hyperinsulinemia (120 min) was evident in all non-diabetic NAFLD cases, and values were higher (151 ± 87 vs 82 ± 53 mU/L, P = 0.001) in those with abnormal OGTT. Patients with established diabetes were more likely to have cirrhosis (40\%) than those with IGT (12\%) or normal glucose tolerance (4\%). CONCLUSIONS: All NAFLD patients have postprandial hyperinsulinemia, and OGTT reveals a high frequency of previously unsuspected IGT or T2D. Such testing would identify individuals who may benefit from early intervention to improve insulin sensitivity and prevent diabetes and progression to cirrhosis. © 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
This article was published in J Gastroenterol Hepatol
and referenced in Journal of Diabetes & Metabolism