Concomitant screening for liver fibrosis and steatosis in French type 2 diabetic patients using Fibroscan

Background: Type 2 diabetes is a risk factor for steatohepatitis and fibrosis. Noninvasive liver stiffness (LS) and controlled attenuation parameter (CAP) measurements by Fibroscan allow assessing liver fat and fibrosis. Aim: To determine the prevalence of steatosis and significant fibrosis in a community-based diabetic population. Methods: LS and CAP were measured in 705 patients using the standard M probe. A second XL probe was used, without CAP measurement, in case of failure with the M probe. Results: LS and CAP measurements were obtained in 437 patients (the M group), LS measurements (LSM) with the XL probe being available in additional 232 patients. After the combined use of both probes, LSM failure and unreliable result were 1.6% and 5.6% respectively, Overall, 12.7% (n=85), 7.3% and 2.1% exhibited significant or advanced fibrosis or cirrhosis (LSM >= 8 kPa, >= 9.6 kPa, >= 13 kPa respectively), half of the patients with LSM >= 8kPa displayed normal liver tests. Significant and severe steatosis were measured in 75% and 24% of the M group patients. By multivariate analysis, factors associated with severe fibrosis were age, overweight, high GGT. Forty-seven patients with LSM >= 8 kPa underwent liver biopsy; 93% had steatosis and 51% severe fibrosis. A significant correlation was found between LSM values and fibrosis score with an accuracy rate of 83%, 68% and 83% for LSM >= 8 kPa, >= 9.6 kPa and >= 13 kPa respectively. Conclusions: The prevalence of significant steatosis is very high and significant fibrosis affect 12.7% of the patients. Fibroscan is an effective procedure to screen for fibrosis and steatosis in diabetic patients.