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Reduced and more appropriate referrals of patients with type 2 diabetes using liver stiffness measurement compared to FIB-4

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Abstract

Background

Fatty liver disease and fibrosis are common in patients with type 2 diabetes mellitus (T2DM). Recently published European Association for the Study of the Liver guidelines have suggested screening such patients using liver stiffness measurement (LSM) or fibrosis-4 index (FIB-4) to exclude advanced fibrosis.

Aims

We initiated a screening programme at the diabetes out-patient clinic to assess the reliability of the suggested approaches and resulting referrals.

Methods

In this prospective study, consecutive patients attending for T2DM review at an Irish level 3 (district general) hospital between September and November 2021 were screened for liver fibrosis using LSM and had their FIB-4 calculated. The first 100 patients with valid LSM measurements were included in the analysis.

Results

Referral rates to the hepatology clinic varied by modality used. If FIB-4 ≥ 1.3 criterion was used, the referral rate to the hepatology clinic was 45%; using LSM < 8 kPa to rule out advanced fibrosis resulted in 34% referral rate; using LSM ≥ 10 kPa to suggest probable compensated advanced chronic liver disease reduced referral rates to 15%. Combining FIB-4 with LSM in a two-step algorithm led to missed potentially significant liver disease in large numbers. 47% patients with LSM ≥ 8 kPa and 33% with LSM ≥ 10 kPa had FIB-4 < 1.3.

Conclusions

Screening of patients with T2DM using LSM alone rather than FIB-4 leads to reduced numbers of, and more appropriate, referrals to the hepatology clinic. Shifting from an exclusion (LSM < 8 kPa) to an inclusion based (LSM ≥ 10 kPa) approach may lessen the potential of screening to overwhelm hepatology services.

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Authors and Affiliations

  1. Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland

    William Shanahan & Paud O’Regan

  2. Department of Endocrinology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland

    Isha Bagwe & Mary Jane Brassill

Authors
  1. William Shanahan
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  2. Isha Bagwe
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  3. Mary Jane Brassill
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  4. Paud O’Regan
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Contributions

Conceptualization: William Shanahan, Mary Jane Brassill, Paud O’Regan; methodology: William Shanahan, Isha Bagwe; formal analysis and investigation: William Shanahan, Isha Bagwe; writing — original draft preparation: William Shanahan; writing — review and editing: Isha Bagwe, Mary Jane Brassill, Paud O’Regan; supervision: Mary Jane Brassill, Paud O’Regan.

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Correspondence to William Shanahan.

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Shanahan, W., Bagwe, I., Brassill, M. et al. Reduced and more appropriate referrals of patients with type 2 diabetes using liver stiffness measurement compared to FIB-4. Ir J Med Sci 192, 649–654 (2023). https://doi.org/10.1007/s11845-022-03019-5

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  • DOI: https://doi.org/10.1007/s11845-022-03019-5

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