PTU-023 Investigating liver function in the diabetic population of a district general hospital

Background The rising prevalence of type 2 diabetes (T2DM) and its complications including non-alcoholic fatty liver disease (NAFLD) is now a leading cause of cirrhosis and hepatocellular cancer. Prompt identification of fibrosis in patients with NAFLD is essential for directing specialist care and improving outcomes. Although T2DM is a major risk factor for NAFLD, there are no guidelines on screening in this population. We aimed to identify the prevalence of liver abnormalities in patients attending secondary care diabetes clinic. In addition we used serum markers to determine degree of fibrosis. Methods All patients attending a diabetes clinic at a single centre over a 24 month period were analysed. Patients with an elevated ALT or ALP were identified. Patient demographics, clinical, imaging and laboratory characteristics were recorded. We analysed the ability to calculate Fibrosis-4 (FIB4) and NAFLD fibrosis scores (NFS) to risk stratify patients. Results Of the 1380 patients assessed, 265 (19%) had elevated ALT and/or ALP, after excluding patients with alternative diagnoses causing liver function derangement. The median age was 64 years, 43.8% were male, mean BMI was 31.8± 6.8 kg/m2. 25.7% of patients underwent an ultrasound scan. 12% of these were suggestive of cirrhosis. Platelet count and AST were available in 85% and 25% respectively. The FIB4 or NFS was calculatable in only 65 patients (25%). FIB4 and NFS scores identified 6% and 14% as indeterminate risk and 2% and 5% as high risk for advanced fibrosis respectively, see figure 1. Of the indeterminate or high risk patients on either score (n=50), all were older than 40, 46% male and 70% had a BMI > 30 kg/m2. Conclusions We highlight minimal rates of recognition of potentially advanced liver fibrosis in a diabetic high risk population. Further education regarding risk stratification using serum markers will identify those patients who need hepatology assessment and monitoring.