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ADA 2018 -- The prevalence of type 2 diabetes (T2DM) and diabetes-associated health burden is increasing world-wide. Diabetic patients are at high risk of developing cirrhosis and liver outcomes, in most cases due to non-alcoholic liver disease (NAFLD). However, liver disease remains a neglected hepatic complication of diabetes. Data on the prevalence of advanced hepatic fibrosis and the main predictors of the progression of liver fibrosis in patients with T2DM are scarce. Numerous non-invasive panels have been developed to stage liver disease. These include a combination of clinical and routine laboratory parameters as well as specialized tests such as biomarkers of fibrosis and elastographic imaging. The FIB-4 index was developed as a non-invasive composite panel to stage liver disease in subjects with HIV-hepatitis C virus co-infection. The aim of the present study was to evaluate liver fibrosis using the FIB-4 score and the changes of this composite index over a 4-year period in a large group of patients with T2DM using a proprietary clinical database from LabCorp.