E0518 - How Common Is Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease in Patients With Primary Biliary Cholangitis

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Elizabeth E. Williams, MD

Indiana University School of Medicine
Indianapolis, IN

Dheeksha Ranginani, BS¹, Elizabeth E. Williams, MD¹, Andrea Mladenovic, MD¹, Raj K. Vuppalanchi, BS, MD²
¹Indiana University School of Medicine, Indianapolis, IN; ²Indiana University, Indianapolis, IN

Introduction: Some studies report a higher prevalence rate of type 2 diabetes mellitus (T2DM) in patients with primary biliary cholangitis (PBC). The presence of T2DM was also associated with more severe fibrosis. In this study, we examined the prevalence of T2DM and nonalcoholic fatty liver disease (NAFLD) as well as the severity of hepatic fibrosis in patients with PBC in those who underwent vibration-controlled transient elastography by FibroScan.

Methods: An IRB approved protocol allowed us to identify patients with ICD9 or ICD 10 diagnosis code for PBC. Individual chart review was performed, and 318 patients met the AASLD criteria for the diagnosis of PBC with a median duration of follow-up of 3.9 years. Patients who underwent liver transplant within 6 months of initial visit were excluded from the current analysis. In addition to study demographics, these individuals were also evaluated for the presence of T2DM, defined as a hemoglobin A1c ≥ 6.5% or use of anti-diabetic drugs anytime during the study duration. NAFLD was identified based on the presence of controlled attenuation parameter (CAP) ≥ 285 dB/m. Student t-test and chi squared analyses were performed to examine the differences between the groups.

Results: The prevalence of T2DM was 17.9% in our study cohort. 52.2% of the study population had a FibroScan performed and 37.3% of them met criteria for NAFLD (Figure 1). Individuals with PBC and T2DM had significantly higher CAP values than those with PBC alone (mean CAP 292.5 vs. 263.8 dB/m, p = 0.013). A greater proportion of the population with PBC and T2DM versus those with PBC alone was noted to have a liver stiffness measurement (LSM) ≥ 8.5 kPa (80.6% vs. 46.4%, p ≤ 0.001) (Table 1).

Discussion: The results suggest that about one in five patients with PBC have concomitant T2DM. PBC patients with T2DM have an increased prevalence of NAFLD and clinically significant fibrosis as evidenced by a higher proportion with LSM ≥ 8.5 kPa.

Figure: Figure 1

	Whole Cohort, n=318 Mean (SD) / n (%)	PBC with T2DM, n=57 Mean (SD) / n (%)	PBC without T2DM, n=261 Mean (SD) / n (%)	P Value*
Age on Initial Visit (years)	59.2 (11.5)	57.7 (9.6)	59.5 (11.8)	0.273
Sex				0.755
Male	30 (9.4)	6 (10.5)	24 (9.2)
Female	288 (90.6)	51 (89.5)	237 (90.8)
Race				< 0.001
White	282 (88.7)	43 (75.4)	239 (91.6)
African American	15 (4.7)	9 (15.8)	15 (2.3)
Asian	6 (1.9)	1 (1.8)	6 (1.9)
Native Hawaiian or Pacific Islander	2 (0.6)	0 (0)	2 (0.8)
Unknown	13 (4.1)	4 (7)	13 (3.4)
Body Mass Index (kg/m²)	29.5 (6.7)	33.3 (7.7)	28.7 (6.2)	< 0.001
≤ 18.5	3 (1.1)	0 (0)	3 (1.3)	0.014
18.5 - 24.9	70 (24.9)	5 (10)	65 (28.1)
25 - 29.9	94 (33.5)	16 (32)	78 (33.8)
≥ 30	114 (40.6)	29 (58)	85 (36.8)
Hypertension	160 (50.3)	41 (71.9)	11 (45.6)	< 0.001
Albumin (g/dl)	3.8 (0.6)	3.8 (0.6)	3.8 (0.5)	0.393
Total Bilirubin (mg/dl)	1.3 (2.4)	1.4 (3.0)	1.3 (2.2)	0.735
Alkaline Phosphatase (U/L)	266.3 (255.5)	247.8 (149.4)	270.5 (273.8)	0.274
AST (U/L)	53.8 (45.8)	44.4 (21.4)	55.9 (49.4)	0.004
ALT (U/L)	54.3 (51.2)	47.6 (31.9)	55.8 (54.5)	0.140
GGT (U/L)	321.33 (349.4)	451.09 (332.8)	300.34 (349.8)	0.093
INR	1.1 (0.2)	1.1 (0.2)	1.1 (0.2)	0.453
Platelets (k/cumm)	225.9 (92.1)	231.4 (105.3)	224.6 (89.0)	0.317
Hemoglobin A1c (%)	5.8 (1.3)	6.8 (1.7)	5.3 (0.5)	< 0.001
CAP (dB/m)	269 (57.4)	292.5 (61.3)	263.8 (55.4)	0.013
LSM (kPa)	15.0 (28.8)	14.0 (9.9)	15.2 (31.5)	0.834
< 8.5	80 (47.3)	6 (19.4)	74 (53.6)	< 0.001
≥ 8.5	89 (52.7)	25 (80.6)	64 (46.4)

Table: Table 1 *Based on chi-square test for categorical data and independent sample t-test for continuous data.

Disclosures:

Dheeksha Ranginani indicated no relevant financial relationships.

Elizabeth Williams indicated no relevant financial relationships.

Andrea Mladenovic indicated no relevant financial relationships.

Raj Vuppalanchi indicated no relevant financial relationships.

Dheeksha Ranginani, BS¹, Elizabeth E. Williams, MD¹, Andrea Mladenovic, MD¹, Raj K. Vuppalanchi, BS, MD². E0518 - How Common Is Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease in Patients With Primary Biliary Cholangitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.