The Impact of Advanced Fibrosis on Quality of Life in Patients with Type 2 Diabetes

Maurice Michel, MD

Credit: University Medical Centre Saarland

People with type 2 diabetes mellitus (T2D) frequently suffer from steatotic liver disease (SLD), particularly metabolic dysfunction-associated steatotic liver disease (MASLD) with liver fibrosis. Results of a German study showed that individuals with advanced fibrosis (AF) had significantly lower health-related quality of life (HRQoL), with obesity and AF identified as independent predictors of poor HRQL, while T2D-related comorbidities did not predict HRQoL impairment.

“An important aspect in the care of patients is the HRQoL—a term that describes the patient’s physical, mental, and social functioning, individual perception of their health status, and the overall well-being associated with the disease,” wrote lead investigator Maurice Michel, MD, resident physician in Internal Medicine at the University Medical Centre Saarland. “Analyzing the HRQoL has major implications for treatment adherence and success, especially within the context of chronic conditions requiring long-term care such as T2D and MASLD.”

Patients with T2D or MASLD and higher disease status often report a lower HRQoL. Those with T2D with lower HRQoL commonly report related comorbidities, such as microvascular and macrovascular complications. This study aimed to evaluate how AF impacts HRQoL in patients with T2D.

A total of 149 participants were enrolled in a German disease management program at primary care facility (Diabetology Practice Mainz). The program was designed to assess diabetes-related comorbidities, to reduce possible associated mortality. Eligible patients were adults aged ≥ 18 years, were diagnosed with T2D and provided written consent prior to study inclusion.

Laboratory values, anthropometric data and patient history were collected at inclusion. Body mass index and waist circumference were calculated, metabolic syndrome was assessed and the alcohol use disorders identification test (AUDIT) was used to identify harmful alcohol consumption.

Vibration-controlled transient elastography (VCTE) and the EuroQoL 5-Dimension 3-Level (EQ-5D-3L) questionnaire were used to determine liver condition and HRQoL, respectively. EQ-5D-3L consists of five factors used to understand a person’s health, including mobility, self-care, anxiety/depression, pain/discomfort and usual activities, along with three levels of response (no problems, moderate problems or extreme problems) for each dimension.

Among patients, 77.9% had SLD—of which 70.7% had MASLD—and 19.5% had AF. The median age was 67 years and 36.9% were female. Cardiovascular disease was more prevalent in patients with AF.

The mean EQ-5D-3L visual analog scale (VAS) and time trade-off (TTO) index value was 71.9 and .85, respectively. Highest scores were observed in the pain/discomfort and mobility dimensions (1.70 and 1.28, respectively), while the lowest mean scores were seen in the self-care dimension (1.05). Among patients with T2D, a high proportion of patients had moderate and extreme problems related to pain/discomfort compared with other dimensions. The anxiety/depression dimension was higher among females compared to males (1.34 vs 1.20, respectively).

Anxiety and depression was higher among patients with AF, although no significant differences were seen when comparing those without AF. More patients with AF had moderate and extreme problems compared with those who did not have AF. Additionally, those in the AF cohort had the second-highest distribution of extreme problems in the anxiety/depression dimension.

The only independent predictors of HRQoL impairment, as measured by the VAS and the TTO index value, were obesity and AF.

“These findings highlight the importance of chronic liver disease with AF in the assessment of this high-risk population,” investigators wrote. “Awareness of liver health and specific interventions may improve patient-reported and liver-related outcomes in people with T2D.”