title: Abnormal liver function tests in patients with Type 1 diabetes mellitus: prevalence, clinical correlations and underlying pathologies.
abstract: OBJECTIVE
  To determine the prevalence of elevated alanine transaminase (ALT) in a large cohort of patients with Type 1 diabetes and to examine the clinical correlations and causes. Methods Patients with Type 1 diabetes mellitus were prospectively recruited and ALT, glycated haemoglobin and lipid profile were measured. Patients with Type 2 diabetes mellitus were recruited as a comparison group.
  
  
  METHODS
  with abnormal ALT were investigated for underlying causes. Prevalence of abnormal ALT was analysed at three separate cut-offs and multivariable analysis used to identify independent risk factors.
  
  
  RESULTS
  Nine hundred and eleven with Type 1 diabetes and 963 with Type 2 diabetes were included. The prevalence of elevated ALT was dependent on the cut-off value: > 30 IU/l in males and > 19 IU/l in females, > 50 and > 63 IU/l was 34.5, 4.3 and 1.9%, respectively, in Type 1 diabetes and 51.4, 8.2 and 3.7%, respectively, in Type 2 diabetes. In Type 1 diabetes an elevated ALT was associated with worse glycaemic control, age > 55 years and elevated triglycerides. Investigation of these patients revealed a cause in 43.6% of patients, predominantly non-alcoholic fatty liver disease (NAFLD).
  
  
  CONCLUSIONS
  Elevated ALT is not uncommon in Type 1 diabetes and is associated with NAFLD-related risk factors. Patients with Type 1 diabetes and elevated ALT should be investigated as significant abnormalities may be found which are amenable to interventions.
authors.affiliation: Departments of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Leeds
authors.forename: E M
authors.initials: EM
authors.lastname: Forman
authors.forename: S
authors.initials: S
authors.lastname: Morley
authors.forename: A R
authors.initials: AR
authors.lastname: Scott
authors.forename: S
authors.initials: S
authors.lastname: Tesfaye
authors.forename: D S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000201:enzymology*; D003924:Diabetes Mellitus, Type 2 / Q000201:enzymology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D008107:Liver Diseases / Q000201:enzymology* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000410:Alanine Transaminase; D006442:Glycated Hemoglobin; D008055:Lipids