title: Prevalence and markers of advanced liver disease in type 2 diabetes.
abstract: BACKGROUND
  Type 2 diabetes is a risk factor for progression of non-alcoholic fatty liver disease (NAFLD) to fibrosis and cirrhosis. We examined the prevalence of advanced liver disease in people with type 2 diabetes and analysed the effectiveness of liver function tests (LFTs) as a screening tool.
  
  
  METHODS
  Participants (n = 939, aged 61-76 years) from the Edinburgh Type 2 Diabetes Study, a randomly selected population of people with type 2 diabetes, underwent abdominal ultrasonography. Hyaluronic acid (HA) and platelet count/spleen diameter ratio (PSR) were used as non-invasive markers of hepatic fibrosis and portal hypertension. Subjects were screened for secondary causes of liver disease that excluded them from a diagnosis of NAFLD. The efficacy of LFTs [alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT)] in screening for liver disease was determined.
  
  
  RESULTS
  Cirrhosis was identified by ultrasound in four participants (0.4%). Ten (1.1%) had evidence of portal hypertension (PSR < 909), and two (0.2%) had hepatocellular carcinoma. Fifty-three participants (5.7%) had evidence of hepatic fibrosis (HA > 100 ng/ml in the absence of joint disease); a further 169 had HA > 50 ng/ml. In participants with NAFLD-related fibrosis (HA > 100 ng/ml), 12.5% had an elevated ALT level and 17.5% had an elevated GGT level.
  
  
  CONCLUSIONS
  The prevalence of hepatic fibrosis and cirrhosis were lower than expected. The use of LFTs to screen for liver disease missed most cases of fibrosis predicted by raised HA levels.
authors.affiliation: Metabolic Unit, Western General Hospital, Edinburgh EH4 2XU, UK. rachel.williamson@luht.scot.nhs.uk
authors.forename: R M
authors.initials: RM
authors.lastname: Williamson
authors.forename: J F
authors.initials: JF
authors.lastname: Price
authors.forename: P C
authors.initials: PC
authors.lastname: Hayes
authors.forename: S
authors.initials: S
authors.lastname: Glancy
authors.forename: B M
authors.initials: BM
authors.lastname: Frier
authors.forename: G I
authors.initials: GI
authors.lastname: Johnston
authors.forename: R M
authors.initials: RM
authors.lastname: Reynolds
authors.forename: M W J
authors.initials: MW
authors.lastname: Strachan
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000032:analysis; D008107:Liver Diseases / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D015995:Prevalence; D011859:Radiography; D013154:Spleen / Q000000981:diagnostic imaging; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase