The Relationship Between Estimated Glucose Treatment Rate And Metabolic Associated Fatty Liver Disease In Type2 Diabetes

Objective:Insulin resistance(IR)is an important pathophysiological mechanism of Type 2 diabetes mellitus(T2DM),and the occurrence and development of Metabolic-associated fatty liver disease(MAFLD)is closely related to IR.The mechanisms that cause IR include inflammation,endoplasmic reticulum oxidative stress,mitochondrial dysfunction,and abnormal signal transduction.The occurrence and development of MAFLD is closely related to IR.The Estimated glucose disposal rate(eGDR)is a simple index used to assess IR calculated from a formula.Taking T2 DM as the study object,we divided the patients into two groups according to the presence or non-presence of MAFLD,compared the differences of eGDR and other parameters between the two groups,analyzed the correlation between eGDR and metabolic parameters,and explored the relationship between eGDR and the occurrence of MAFLD as well as the predictive value of eGDR in the occurrence of MAFLD in T2 DM patients.To provide predictive indexes for early prevention and treatment of MAFLD.Methods:A retrospective analysis was performed on 1434 patients with type 2diabetes admitted to the Department of Endocrinology of Hebei Provincial People’s Hospital from January 2019 to December 2019.Clinical information of patients was collected and Total cholesterol,Triglyceride(TG),High density lipoprotein cholesterol(HDL-C),Low density lipoprotein cholesterol(Low density lipoprotein)cholesterol,LDL-C,Fasting blood glucose(FBG),Glycosylated hemoglobin,Hb A1c),Aspartate aminotransferase(AST),Alanine aminotransferase(ALT),Gamma-glutamyl transferase(GGT),Bile acid(BA),Serum uric acid(SUA),Serum creatinine(SCr),albumin(ALB)and other metabolic indicators.eGDR index was calculated according to the formula eGDR=19.02-[0.22 ×BMI(kg/m2)]-(3.26 ×HT)-(0.61× Hb A1c%)],where HT was hypertension(yes =1,no =0).Two groups were divided according to whether there was a MAFLD or not.eGDR and baseline data of the two groups were analyzed and compared.Group T1: eGDR≤5.09 Group T2:eGDR ≤ 5.10-7.11 Group T3: eGDR>7.12 was used to analyze the difference between the above indexes and the three groups.The lower eGDR was,the more severe IR was.Spearman correlation analysis and Logistic regression were used to analyze the correlation between eGDR and the above indexes and MAFLD.Receiver operating characteristic curve(ROC)was established and the area under the curve was calculated to explore the predictive value of eGDR model to MAFLD.All data were statistically analyzed using SPSS25.0 software.Results:1.Comparison of general data: A total of 734 patients were diagnosed with MAFLD in 1434 patients with T2 DM,with a detection rate of 51%.Compared with patients without MAFLD,patients with MAFLD had higher proportion of drinkers,higher proportion of hypertension and higher proportion of smokers,significantly higher levels of BMI,FBG,SUA,TG,TC,LDL-C,ALT,AST,GGT and ALB,younger age,shorter course of disease,lower levels of HDL-C and eGDR.There were statistical differences(P<0.05).Compared with eGDR T3 group,eGDR T1 group had higher proportion of hypertension,older age,higher levels of BMI,FBG,Hb Alc,SUA,SCr,TG and GGT,and lower levels of HDL-C and ALB,with statistical differences(P<0.05).2.Spearman correlation analysis: In the MAFLD group,eGDR was negatively correlated with age,FBG,ALB;in the non-MAFLD group,eGDR was negatively correlated with age,disease course,FBG,SCr,TG,ALB,and positively correlated with HDL-C,AST,and GGT.3.Logistic regression analysis: univariate Logistic regression analysis showed that age,sex,smoking,alcohol consumption,SUA,TG,HDL-C,LDL-C,AST,ALT,GGT,BA,ALB and eGDR were associated with the risk of developing MAFLD.In multivariate Logistic regression analysis,low eGDR was an independent risk factor for MAFLD after adjusting for confounding factors.Subgroup analysis showed that there was an interaction between eGDR and MAFLD in BMI,GGT,and hypertension subgroup(P<0.05),and the correlation between eGDR and MAFLD was stronger in BMI>24kg/m2,GGT>31.5U/L,and hypertension subjects.4.ROC curve results showed that the AUC(95%CI)of eGDR model for T2 DM patients with MAFLD was 0.743(0.715,0.771),suggesting that eGDR model had good predictive value for T2 DM patients with MAFLD(P<0.001).Conclusion:1.The proportion of hypertension patients in T2 DM combined with MAFLD group increased,the level of BMI and FBG increased,and the level of eGDR decreased significantly.2.T2 DM patients with low eGDR levels had a higher risk of MAFLD,and the relationship between eGDR level and risk of MAFLD was more significant in patients with BMI>24kg/m2,GGT>31.5U/L and hypertension.3.eGDR model has predictive value for T2 DM patients with MAFLD.