Liver fibrosis and diabetic peripheral neuropathy in individuals with type 2 diabetes mellitus: observational, cross-sectional study 

Aim: To evaluate the association between liver fibrosis, investigated by non-invasive fibrosis scores and measurement of stiffness, and diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM).

Methods: Cross-sectional, retrospective study including individuals with T2DM and hepatic steatosis that have performed a DPN examination. Liver fibrosis risk was estimated using FIB-4, NFS, AST/ALT ratio, and APRI. Fibrosis was investigated using the vibration controlled transient elastography (VCTE, Fibroscan®) in a subgroup of patients. Liver stiffness measurement (LSM) ≥ 7.0 kPa defined significant fibrosis.

Results: Eighty-six T2DM subjects (mean age 59.22 ± 13.18 years; 69,8% male; DPN prevalence 43%) were included. Higher risk scores of liver fibrosis (FIB-4 and AST/ALT) in subjects with DPN compared to those without DPN were detected (FIB-4: 1.23 ± 0.66 vs. 1.63 ± 0.85; P 0.018; AST/ALT: 0.89 ± 0.23 vs. 1.11 ± 0.61; P 0.026). DPN group showed higher LSM value and Michigan Diabetic Neuropathy Score (MDNS) score was directly related to LSM (Rho: 0.304, P = 0.026). Moreover, higher prevalence of alteration in vibration or reflexes was observed in subjects with LSM ≥ 7 kPa (P = 0.025 and P = 0.042, respectively). Finally, the evaluation of vibration or reflexes in individuals at high risk of liver fibrosis at FIB-4 and AST/ALT was associated with DPN (FIB-4 + abnormal vibration: P = 0.047; FIB-4 + abnormal reflexes: P = 0.013; AST/ALT + abnormal vibration: P < 0.001; AST/ALT + abnormal reflexes: P < 0.001).

Conclusion: The evaluation of vibration or reflexes would be useful in identifying DPN in T2DM with MASLD at high risk of fibrotic evolution.