title: Prevalence of elevated liver enzymes in adults with type 1 diabetes: A multicentre analysis of the German/Austrian DPV database.
abstract: To assess the prevalence of elevated liver enzymes in adults with type 1 diabetes mellitus (T1DM) in routine clinical care and the association with cardiovascular risk profile in the Diabetes-Prospective-Documentation (DPV) network in Germany and Austria.
  
  
  
  This cross sectional observational study from the DPV registry includes data from 45 519 adults with T1DM at 478 centres up to September 2016. Liver enzyme measurements were available in 9226 (29%) patients at 270 centres and were analysed for increased alanine aminotransferase (ALT; men >50 U/L, women >35U/L) and/or aspartate aminotransferase (AST; men >50 U/L, women >35U/L) and/or gamma-glutamyltransferase (GGT; men >60U/L, women >40 U/L). A subgroup analysis in patients for whom 2 or more ALT measurements were available (n = 2335, 25%) and whose ALT was increased at least twice (men >30 U/L, women >19U/L) was performed. Associations with glycaemic control, cardiovascular risk factors and late complications were investigated with multiple regression analyses.
  
  
  
  Twenty percent (19.8%, n = 1824) had increased liver enzyme(s) on one or more occasions. Increased liver enzymes were associated with worse glycaemic control and higher BMI (both P < .0001), dyslipidemia (OR, 1.75; 95% CI, 1.54-2.0), hypertension (OR, 1.48; 95% CI: 1.31-1.68), myocardial infarction (OR, 1.49; 95% CI, 1.17-1.91) and end stage renal disease (OR, 1.59; 95% CI, 1.17-2.17). ALT was increased twice in 29% and was associated with worse glycaemic control (P < .0001), higher BMI (P < .0001), hypertension (OR, 1.58; 95% CI, 1.26-1.97) and dyslipidemia (OR, 1.89; 95% CI, 1.51-2.37).
  
  
  
  In this clinical audit in adults with T1DM, elevated liver enzymes on routine assessment were associated with a less favourable cardiovascular risk profile and with poorer glycaemic control.
authors.affiliation: Diabetes Research Group, King's College London, London, UK.|3rd Medical Department, Hietzing Hospital Vienna, Vienna, Austria.
authors.forename: Marietta
authors.identifier: 0000-0001-6869-9960
authors.initials: M
authors.lastname: Stadler
authors.affiliation: Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.|German Centre for Diabetes Research (DZD), Neuherberg, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: Bollow
authors.affiliation: Department of Pediatric and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
authors.forename: Maria
authors.initials: M
authors.lastname: Fritsch
authors.affiliation: Klinik für Diabetes & Stoffwechselkrankheiten, Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH & Co. KG, Karlsburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kerner
authors.affiliation: 3rd Medical Department, Hietzing Hospital Vienna, Vienna, Austria.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schuetz-Fuhrmann
authors.affiliation: Diabeteszentrum Forchheim, Forchheim, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Krakow
authors.affiliation: Diabetes and Endocrinology Department, Klinikum Coburg, Germany.
authors.forename: Sigrun
authors.initials: S
authors.lastname: Merger
authors.affiliation: Internal Medicine III, Medical University Vienna, Vienna, Austria.
authors.forename: Michaela
authors.initials: M
authors.lastname: Riedl
authors.affiliation: Klinik für Innere Medizin I, Ev. Krankenhaus Paul-Gerhardt-Stift, Paul-Gerhardt-Diakonie Krankenhaus und Pflege GmbH, Lutherstadt Wittenberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Jehle
authors.affiliation: Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.|German Centre for Diabetes Research (DZD), Neuherberg, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000328:Adult; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D048550:Hepatic Insufficiency / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D008099:Liver / Q000503:physiopathology*; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: cardiovascular; liver enzymes; type 1 diabetes