Association between steatotic liver disease and microvascular complications in individuals with type 2 diabetes: a cohort study in the UK Biobank
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: Cross-sectional studies have revealed that steatotic liver disease (SLD) is associated with prevalent diabetic microvascular complications, but longitudinal evidence in large samples is insufficient. We aimed to prospectively investigate the association between SLDs and the risk of microvascular complications in patients with type 2 diabetes (T2D), and to explore whether glycemic control played a mediating role in this association.
Methods: The population-based cohort, which was based on the UK Biobank study, included 25,630 T2D patients at baseline. SLD was defined as a fatty liver index ≥ 60. A glycated hemoglobin level ≥ 7% (53 mmol/mol) was considered poor glycemic control. The primary outcome was total incident diabetic microvascular complications, defined as the first occurrence of diabetic nephropathy, diabetic neuropathy, and/or diabetic retinopathy. The cox proportional hazard regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetic microvascular complications. Mediation analysis was applied to explore whether the association between SLDs and diabetic microvascular complications was mediated by glycemic control.
Results: The mean age of the study participants was 59.6 years, and 58.1% of them were males. During a median follow-up period of 12.1 years, 5,171 participants were diagnosed with microvascular complications. Compared with non-SLD participants, SLD participants had a HR of 1.15 (95% CI: 1.04, 1.27) for total microvascular complications, a HR of 1.20 (95% CI: 1.06, 1.35) for diabetic nephropathy, a HR of 1.05 (95% CI: 0.91, 1.21) for diabetic retinopathy, and a HR of 1.46 (95% CI: 1.15, 1.86) for diabetic neuropathy. The results of the mediation analysis revealed that the mediating proportion of glycemic control in the association between the SLD group and total diabetic microvascular complications was 22.5% (95% CI: 10.4%, 91.0%).
Conclusions: SLD was associated with an increased risk of microvascular complications, especially diabetic nephropathy and diabetic neuropathy, in T2D patients. Glycemic control partially mediated the association between SLDs and diabetic microvascular complications.
Methods: The population-based cohort, which was based on the UK Biobank study, included 25,630 T2D patients at baseline. SLD was defined as a fatty liver index ≥ 60. A glycated hemoglobin level ≥ 7% (53 mmol/mol) was considered poor glycemic control. The primary outcome was total incident diabetic microvascular complications, defined as the first occurrence of diabetic nephropathy, diabetic neuropathy, and/or diabetic retinopathy. The cox proportional hazard regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetic microvascular complications. Mediation analysis was applied to explore whether the association between SLDs and diabetic microvascular complications was mediated by glycemic control.
Results: The mean age of the study participants was 59.6 years, and 58.1% of them were males. During a median follow-up period of 12.1 years, 5,171 participants were diagnosed with microvascular complications. Compared with non-SLD participants, SLD participants had a HR of 1.15 (95% CI: 1.04, 1.27) for total microvascular complications, a HR of 1.20 (95% CI: 1.06, 1.35) for diabetic nephropathy, a HR of 1.05 (95% CI: 0.91, 1.21) for diabetic retinopathy, and a HR of 1.46 (95% CI: 1.15, 1.86) for diabetic neuropathy. The results of the mediation analysis revealed that the mediating proportion of glycemic control in the association between the SLD group and total diabetic microvascular complications was 22.5% (95% CI: 10.4%, 91.0%).
Conclusions: SLD was associated with an increased risk of microvascular complications, especially diabetic nephropathy and diabetic neuropathy, in T2D patients. Glycemic control partially mediated the association between SLDs and diabetic microvascular complications.
Date Issued
2025-05-28
Date Acceptance
2025-05-06
Citation
Frontiers in Endocrinology, 2025, 16
ISSN
1664-2392
Publisher
Frontiers Media S.A.
Journal / Book Title
Frontiers in Endocrinology
Volume
16
Copyright Statement
© 2025 Liu, You, Yu, Lett, Wu, Zeng, Fan, Chen, Fu and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40502403
Subjects
Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
steatotic liver disease
type 2 diabetes
microvascular complications
cohort
glycemic control
CHRONIC KIDNEY-DISEASE
RETINOPATHY
RISK
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
1554798
Date Publish Online
2025-05-28