Liver fibrosis is independently associated with diabetic peripheral neuropathy in type 2 diabetes mellitus

Abstract

Aims/Introduction Non‐alcoholic fatty liver disease and type 2 diabetes mellitus are closely related, and often occur simultaneously in patients. Type 2 diabetes increases the risk of diabetic peripheral neuropathy, resulting in intolerable pain and extremity amputation that reduces the quality of life. However, the role of non‐alcoholic fatty liver disease in the pathogenesis of diabetic peripheral neuropathy remains unclear. Thus, we evaluated the correlation of liver fibrosis and steatosis, which are representative histological morphologies of non‐alcoholic fatty liver disease, with diabetic peripheral neuropathy in type 2 diabetes patients. Materials and Methods Five hundred twenty individuals with type 2 diabetes were recruited. All the patients were detected nerve conduction study for diabetic peripheral neuropathy and fibro touch for liver steatosis and fibrosis. Correlation of DPN with liver steatosis and fibrosis were analysed with binary logistic analysis. Results Among the 520 patients, the prevalence of liver steatosis, fibrosis and diabetic peripheral neuropathy was 63.0% (n = 328), 18.1% (n = 94) and 52.1% (n = 271), respectively. The prevalence of diabetic peripheral neuropathy was significantly elevated in patients with liver steatosis (55.7 vs 44.9%, P = 0.03) and fibrosis (61.5 vs 50%, P = 0.04), and it increased as liver stiffness measurement increased. Additionally, both hepatic steatosis (odds ratio 1.48, 95% confidence interval 1.04–2.11, P = 0.03) and fibrosis (odds ratio 1.60, 95% confidence interval 1.02–2.51, P = 0.04) were correlated with diabetic peripheral neuropathy. After adjusting for age, sex, weight, height, body mass index, waist hip ratio, duration of type 2 diabetes, blood glucose, homeostatic model assessment of insulin resistance, blood pressure, serum lipid, liver enzyme, urea, uric acid, creatinine and inflammatory factors, liver fibrosis remained associated with diabetic peripheral neuropathy (odds ratio 2.24, 95% confidence interval 1.11–4.53, P = 0.02). Conclusions The prevalence of diabetic peripheral neuropathy was elevated in patients with liver steatosis and fibrosis. Liver fibrosis was also independently associated with an increased risk of diabetic peripheral neuropathy.

Association of Nonalcoholic Fatty Liver Disease (NAFLD) with Peripheral Diabetic Polyneuropathy: A Systematic Review and Meta-Analysis

“…The literature search identified 2613 papers, after duplication removal. After abstract evaluations, 16 studies were considered for the full text analysis [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (Figure 1). Three studies have been excluded, since one is a duplication of previously published results [45], and two works did not report the prevalence of neuropathy in NAFLD positive and negative patients [43,44] (Figure 1).…”

Clinical Model for the Prediction of Severe Liver Fibrosis in Adult Patients with Type II Diabetes Mellitus

“…In light of this data, our study supports the notion that the prevalence of severe fibrosis, the main determinant of mortality in NAFLD, is higher in patients with metabolic alterations. Other studies found a bidirectional correlation between liver fibrosis and peripheral diabetic neuropathy, suggesting possible common etiological mechanisms [ 47 , 48 , 49 ].…”

Liraglutide on type 2 diabetes mellitus with nonalcoholic fatty liver disease: A systematic review and meta-analysis of 16 RCTs

“…It causes a gradual development of fatty liver, liver fibrosis and even liver failure. [ 55 ] Disorders of glycolipid metabolism, obesity, as well as IR are prevalent in patients with NAFLD. [ 56 ] T2DM and NAFLD can affect themselves each other.…”