The Correlation between Estimated Glucose Disposal Rate (eGDR) and the Severity of Nonalcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes
eGDRand the severity of NAFLD
DOI:
https://doi.org/10.35516/jmj.v59i5.3109Keywords:
Diabetes; estimated glucose disposal rate (eGDR); insulin sensitivity; Nonalcoholic Fatty Liver Disease (NAFLD); screening.Abstract
Purpose: To correlate between the degree of insulin sensitivity and degree of nonalcoholic fatty liver disease (NAFLD) in type 2 Diabetes.
Methods: Our study included a total of 211 patients. For each participant, we calculated the Fibrosis-4 Index (FIB-4), an indicator for assessing the presence of advanced liver fibrosis, and the NAFLD score, which assesses the extent of liver fibrosis. These scores were then correlated with the estimated Glucose Disposal Rate (eGDR), a measure used to evaluate insulin sensitivity.
Results: The mean FIB-4 score was 1.22 ± 1.54, and the mean NAFLD score was -0.75 ± 1.46. Moderate to severe fibrosis was present in 2.8% of patients according to the FIB-4 score and in 10.9% according to the NAFLD score. The mean eGDR score was 4.58 ± 2.41. Spearman correlation coefficients demonstrated that eGDR was weakly but significantly correlated with the FIB-4 score (r = -0.143, p = 0.042). Additionally, eGDR showed a significant correlation with NAFLD scores (r = -0.344, p < 0.001). The FIB-4 score was also significantly correlated with NAFLD scores (r = 0.821, p < 0.001). ROC curves demonstrated that eGDR significantly predicted moderate-severe fibrosis indicated by FIB-4 (71.1%; 95% CI: 58.3%-83.8%) or NAFLD scores (73.4%; 95% CI: 63.0%-83.8%). The optimal cut-off point for eGDR to predict moderate-severe fibrosis indicated by FIB-4 was 4.07, achieving a sensitivity of 65.2% and specificity of 73.8%. For predicting moderate-severe fibrosis indicated by NAFLD scores, the optimal eGDR cut-off point was 5.34, with a sensitivity of 83.3% and specificity of 65.5%.
Conclusion: Our study demonstrated a significant correlation between eGDR scores and the severity of NAFLD. Based on our findings, we suggest considering a lower cut-off point for eGDR, specifically between 4.07 to 5.34, to enhance the prediction of NAFLD in the context of insulin resistance.
References
Nogueira JP; Cusi K. Role of Insulin Resistance in the Development of Nonalcoholic Fatty Liver Disease in People with Type 2 Diabetes: From Bench to Patient Care. Diabetes Spectr 2024;37(1):20–28. https://doi.org/10.2337/dsi23-0013
Bril F, Sanyal A, Cusi K. Metabolic syndrome and its association with nonalcoholic steatohepatitis. Clin Liver Dis 2023;27: 187–210.
En Li Cho E, Ang CZ, Quek J, Fu CE, Lim LKE, et al. Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis. Gut. 2023;72(11):2138-48. doi: 10.1136/gutjnl-2023-330110.
Introduction and Methodology: Standards of Care in Diabetes—2023 Diabetes Care 2023;46(Suppl. 1): S1–S4 | https://doi.org/10.2337/dc23-SINT.
J J Liu, S Liu, K A Ang, S C Lim, Estimated glucose disposal rate, a novel biomarker for insulin sensitivity, predicts risk for incident heart failure in patients with type 2 diabetes, European Heart Journal 2023; 44 (Suppl.1), ehac779.035, https://doi.org/10.1093/eurheartj/ehac779.035.
Ajlouni K, Batieha A, Jaddou H, Khader Y, Abdo N, El-Khateeb M, Hyassat D, Al-Louzi D. Time trends in diabetes mellitus in Jordan between 1994 and 2017. Diabet Med. 2019;36(9):1176-82.
Awad SF, Huangfu P, Dargham SR, Ajlouni K, Batieha A, Khader YS, Critchley JA, Abu-Raddad LJ. Characterizing the type 2 diabetes mellitus epidemic in Jordan up to 2050. Sci Rep. 2020;10(1):21001.
Judi L., Toukan A., Khader Y., Ajlouni K., Khatib M.A. Prevalence of elevated hepatic transaminases among Jordanian patients with type 2 diabetes mellitus. Ann. Saudi Med. 2010;30(1):25–32. doi: 10.4103/0256-4947.59369.
Almahmoud MH, Al Khawaja NM, Alkinani A, Khader Y, Ajlouni KM. Prevalence of fatty liver disease and its associated factors among Jordanian patients with type 2 diabetes mellitus: A cross-sectional study. Ann Med Surg (Lond). 2021 Aug 6; 68:102677.
Anstee QM, Berentzen TL, Nitze LM, Jara M, Jensen AB, et al. Prognostic utility of Fibrosis-4 Index for risk of subsequent liver and cardiovascular events, and all-cause mortality in individuals with obesity and/or type 2 diabetes: a longitudinal cohort study. Lancet Reg Health Eur. 2023;36:100780.
doi: 10.1016/j.lanepe.2023.100780.
Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, Enders F, Saksena S, Burt AD, Bida JP, Lindor K, Sanderson SO, Lenzi M, Adams LA, Kench J, Therneau TM, Day CP. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007 Apr;45(4):846-54. doi: 10.1002/hep.21496.
Younossi ZM. Non-alcoholic fatty liver disease - A global public health perspective. J Hepatol. 2019;70(3):531-44.
doi: 10.1016/j.jhep.2018.10.033.
Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic Steatohepatitis: A Review. JAMA. 2020; 24:323(12):1175-83.
doi: 10.1001/jama.2020.2298.
Salas-Salvadó J, Díaz-López A, Ruiz-Canela M, Basora J, Fitó M, Corella D, et al. Effect of a Lifestyle Intervention Program with Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial. Diabetes Care. 2019; :42(5):777-88. doi: 10.2337/dc18-0836.
Gastaldelli A. Measuring and estimating insulin resistance in clinical and research settings. Obesity (Silver Spring). 2022;30(8):1549-63. doi: 10.1002/oby.23503.
Ascaso JF, Pardo S, Real JT, Lorente RI, Priego A, Carmena R. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care. 2003 Dec;26(12):3320-5.
doi: 10.2337/diacare.26.12.3320.
Antuna-Puente B, Faraj M, Karelis AD, Garrel D, Prud'homme D, Rabasa-Lhoret R, Bastard JP. HOMA or QUICKI: is it useful to test the reproducibility of formulas? Diabetes Metab. 2008 Jun;34(3):294-6.
doi: 10.1016/j.diabet.2008.02.001.
Lam-Chung CE, Martínez Zavala N, Ibarra-Salce R, Pozos Varela FJ, Mena Ureta TS, et al. Association of estimated glucose disposal rate and chronic diabetic complications in patients with type 1 diabetes. Endocrinol Diabetes Metab. 2021;4(4):e00288. doi: 10.1002/edm2.288.
Januszewski AS, Sachithanandan N, Ward G, Karschimkus CS, O'Neal DN, Jenkins AJ. Estimated insulin sensitivity in Type 1 diabetes adults using clinical and research biomarkers. Diabetes Res Clin Pract. 2020; 167:108359. doi: 10.1016.
Nyström T, Holzmann MJ, Eliasson B, Svensson AM, Sartipy U. Estimated glucose disposal rate predicts mortality in adults with type 1 diabetes. Diabetes Obes Metab. 2018;20(3):556–63. doi: 10.1111/dom.13110.
Li Z, Qi C, Jia Z, Zhen R, Ren L, Jia Y, Chen S. The Correlation Between Estimated Glucose Disposal Rate and Coagulation Indexes in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2022; 31:15:2643-52.
doi: 10.2147/DMSO.S371457.
Lu Z, Xiong Y, Feng X, Yang K, Gu H, et al. Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients. Cardiovasc Diabetol. 2023; 26:22(1):225. doi: 10.1186/s12933-023-01925-1.
Patel K, Sebastiani G. Limitations of non-invasive tests for assessment of liver fibrosis. JHEP Rep. 2020 Jan 20;2(2):100067.
doi: 10.1016/j.jhepr.2020.100067.
Boursier J, Tsochatzis EA. Case-finding strategies in non-alcoholic fatty liver disease. JHEP Rep. 2020 Dec 5;3(2):100219.
doi: 10.1016/j.jhepr.2020.100219.
Anstee QM, Berentzen TL, Nitze LM, Jara M, Jensen AB, et al. Prognostic utility of Fibrosis-4 Index for risk of subsequent liver and cardiovascular events, and all-cause mortality in individuals with obesity and/or type 2 diabetes: a longitudinal cohort study. Lancet Reg Health Eur. 2023;19 (36):100780.
doi: 10.1016/j.lanepe.2023.100780.
Whang JY, Park PG, Park YB, Huh JH, Lee SW. Non-alcoholic fatty liver disease fibrosis score is a useful index for predicting all-cause mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis. Front Med (Lausanne). 2023;10:1217937.
doi: 10.3389/fmed.2023.1217937.
Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846-54. doi: 10.1002/hep.21496.
