Background & Aims

Improvement of fatty liver may be required for remission of type-2 diabetes. However, there is no longitudinal evidence on whether fatty liver reduces the chances for remission of type-2 diabetes. We investigated the association between fatty liver and remission of type-2 diabetes (the primary analysis), and also the association between improvement of fatty liver and remission of type-2 diabetes (the secondary analysis).

Methods

We collected data from 66961 people who underwent screening for type-2 diabetes from 2008 through 2016 at a single center in Japan. The primary analysis included 2567 patients with type-2 diabetes without chronic renal failure or a history of hemodialysis who underwent ultrasonography to detect fatty liver, all of whom had follow-up testing, including blood testing, for a median 24.5 months after the baseline ultrasonography. The secondary analysis included 1833 participants with fatty liver at baseline who underwent a second ultrasonography, and participants who had fatty liver at baseline but not at the second visit were considered to have had improvement of fatty liver. Remission of type-2 diabetes was defined as a fasting plasma glucose level below 126 mg/dL and an HbA1c level below 6.5% for more than 6 months without anti-diabetic drugs. Odds ratios (ORs) of remission of type-2 diabetes were estimated using logistic-regression models.

Results

A lower proportion of patients who had fatty liver detected by ultrasonography at baseline (8.7%, 167/1910) had remission of type-2 diabetes during the follow-up period than patients without fatty liver (13.1%, 86/657). Fatty liver at baseline was associated with a lower odds of remission of type-2 diabetes (multivariable-adjusted OR, 0.51; 95% CI, 0.37–0.72). A higher proportion of patients who had improvement of fatty liver had remission of type-2 diabetes (21.1%, 32/152) than patients with no improvement of fatty liver (7.7%, 129/1681). Improvement of fatty liver was associated with a higher odds of remission of type-2 diabetes (multivariable-adjusted OR, 3.08; 95% CI, 1.94–4.88).

Conclusions

Over a follow-up period of approximate 2 years, remission of type-2 diabetes was less common in people with fatty liver detected by ultrasonography, and improvement of fatty liver was independently associated with type-2 diabetes remission.

中文翻译：

---

基线超声检查中脂肪肝与 2 年随访期间 2 型糖尿病缓解之间的负相关

背景与目标

缓解 2 型糖尿病可能需要改善脂肪肝。然而，没有纵向证据表明脂肪肝是否会降低 2 型糖尿病缓解的机会。我们调查了脂肪肝与 2 型糖尿病缓解之间的关联（主要分析），以及脂肪肝改善与 2 型糖尿病缓解之间的关联（次要分析）。

方法

我们收集了 2008 年至 2016 年在日本单一中心接受 2 型糖尿病筛查的 66961 人的数据。主要分析包括 2567 名无慢性肾功能衰竭或有血液透析史的 2 型糖尿病患者，他们接受了超声检查以检测脂肪肝，所有这些患者在基线超声检查后的中位时间为 24.5 个月进行了随访检查，包括血液检查. 次要分析包括 1833 名基线脂肪肝患者，他们接受了第二次超声检查，基线脂肪肝但在第二次就诊时没有的参与者被认为脂肪肝有所改善。2 型糖尿病的缓解定义为空腹血糖水平低于 126 mg/dL 且 HbA1c 水平低于 6.5% 且持续 6 个月以上且未使用抗糖尿病药物。

结果

基线超声检测到脂肪肝的患者（8.7%，167/1910）在随访期间2型糖尿病缓解的比例低于没有脂肪肝的患者（13.1%，86/657）。基线时的脂肪肝与较低的 2 型糖尿病缓解几率相关（多变量调整 OR，0.51；95% CI，0.37-0.72）。与脂肪肝没有改善的患者（7.7%，129/1681）相比，脂肪肝有改善的患者2型糖尿病缓解的比例更高（21.1%，32/152）。脂肪肝的改善与更高的 2 型糖尿病缓解几率相关（多变量调整的 OR，3.08；95% CI，1.94-4.88）。

结论

在大约 2 年的随访期间，2 型糖尿病的缓解在超声检查发现的脂肪肝患者中不太常见，而脂肪肝的改善与 2 型糖尿病的缓解独立相关。