title: Prevalence and natural history of histologically proven chronic liver disease in a longitudinal cohort of patients with type 1 diabetes.
abstract: Although a higher prevalence of raised liver enzymes and altered echotexture on ultrasound have been reported in patients with type 1 diabetes mellitus (T1DM), the histological spectrum and natural history of chronic liver disease (CLD) in T1DM is unknown. We investigated the prevalence and outcome of histologically proven CLD in a longitudinal cohort of patients with T1DM. We identified patients who have had liver biopsy from a computerized database (DIAMOND; Hicom Technology, Brookwood, UK) containing longitudinal data for over 95% of type 1 diabetes patients from an overall catchment population of 700,000 people. Gender-matched patients with oral hypoglycemic-treated (T2OH) and insulin-treated type 2 diabetes (T2IN) who had liver biopsy formed two comparative cohorts. We collated clinical and histological data, as well as long-term outcomes of all three groups, and compared T1DM cirrhosis incidence to UK general population data. Of 4,644 patients with T1DM, 57 (1.2%) underwent liver biopsy. Of these, 53.1% of patients had steatosis, 20.4% had nonalcoholic steatohepatitis, and 73.5% had fibrosis on index liver biopsy. Cirrhosis was diagnosed in 14 patients (24.6%) during follow-up. T1DM with age under 55 years had an odds ratio of 1.875 (95% confidence interval: 0.936-3.757) for cirrhosis incidence, compared to the general population. Longitudinal liver-related outcomes were similar comparing the T1DM cohort and respective type 2 diabetes cohorts--when adjusted for important confounders, diabetic cohort type did not predict altered risk of incident cirrhosis or portal hypertension.
  
  
  CONCLUSIONS
  Type 1 diabetes is associated with a previously unrecognized burden of CLD and its complications.
authors.affiliation: National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit (NDDBRU), Nottingham University Hospitals NHS Trust and University of Nottingham, United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Harman
authors.forename: Philip V
authors.initials: PV
authors.lastname: Kaye
authors.forename: Rebecca
authors.initials: R
authors.lastname: Harris
authors.forename: Ayako
authors.initials: A
authors.lastname: Suzuki
authors.forename: Anastasios
authors.initials: A
authors.lastname: Gazis
authors.forename: Guruprasad P
authors.initials: GP
authors.lastname: Aithal
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D058625:End Stage Liver Disease / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors