Correlations Between Insulin

Resistance and Blood Sugar

Control with Degree of Liver
Fibrosis in Type 2 Diabetic
Patient with Non Alcoholic Fatty
Liver

Shinta Merina Latulola, B.J. Waleleng, Yuanita A Langi

Internal Medicine Department, Faculty of Medicine Sam Ratulangi
University- Prof dr R.D Kandou General Hospital , Manado, Indonesia
Background

NAFLD Chronic liver disease with excessive fat accumulation in

liver
Simple fatty liver Non Alcoholic Steatohepatitis Liver Fibrosis
Cirrhosis
NAFLD strongly associated with T2DM (Hyperglycaemia and Insulin
Resistance)
Background

Pathogenesis not fully understood,

Insulin resistance and mitochondria dysfunction are considered
Two Hit Theory by Day and James
The aim of this study was to determine the correlation between
Insulin Resistance (HOMA-IR) and blood sugar control (HBA1C) with
the degree of fibrosis in T2DM patients with NAFLD.
Methods

Cross sectional analytic study

Patients aged 17-70 years with T2DM and Non Alcoholic
Fatty Liver
The degree of liver Fibrosis measured by NAFLD Fibrosis
Score
Inpatient DMT2, Patient with hepatitis B, hepatitis C,
alcoholic, pregnancy are excluded from the study
RESULT & DISCUSSION
General Characteristics of Samples
There were 40 patients obtained in this study
Table 1. Characteristics of Study Sample
Karakteristik N Min Max Med Mean SD

Umur (tahun) 40 31 70 60,00 58,08 8,985

IMT 40 20,57 33,62 25,8000 26,2688 3,04049

SGOT 40 12,00 54,00 22,0000 23,8750 9,36219

SGPT 40 11,00 63,00 22,5000 25,0750 11,30098

Albumin 40 4,00 4,70 4,3000 4,3075 0,18727

Platelet 40 165 574 278,00 287,65 83,321

Homa-IR 40 0,71 31,22 2,7300 4,7145 5,49585

Insulin Puasa 40 2,10 74,90 7,6000 11,9450 13,13283

HbA1C 40 5,40 12,00 7,6000 8,1525 1,93125

Fibrosis 40 -2,423 3,639 1,29200 1,06583 1,264033

Lama DM 40 0,30 24,00 5,0000 6,3888 5,26358

 RESULT & DISCUSSION F0-F2
-NAFLD Fibrosis Score Result
7.5 %

INTERMEDIET 25 %

F3-F4
67.5 %
RESULT & DISCUSSION
r = -0,149
P = 0,179
The same Result with
Wyszomirska et al.
Different Result with Singh et al
and Nakahara et al.
Depends on the level Fasting
Insulin Patient
RESULT & DISCUSSION

r = -0,19
P = 0,453
Matsuba et al, 2010
The longer a patient DM the lower
fasting insulin level
Fasting Insulin = Homa IR
In this study :
Fasting Insulin = Homa IR
RESULT & DISCUSSION

r = 0,238 Positive correlation but not significant

P = 0,069
Duration of DM Duration of
hyperInsulinemia

The Hyperinsulinemia
stimulates lipogenesis

Fat accumulation in the liver

RESULT & DISCUSSION
The same result with Manuel et al, Ferreira
r = - 0,188
P = 0,123
et al and Yoosoo Chang et al
A different result with Han Ma et al
Research setting in non diabetic
patient
Some factors are suspected to influence
result of the research :
HbA1C only monitors the blood sugar for 8-
12 weeks
The duration of diabetic
Subject T2DM on treatment with metformin
Conclusion
In this Study, there was no correlation between insulin resistance
(HOMA-IR) and degree of liver fibrosis in subject with T2DM
In this study, there was no correlation between blood sugar control
(HbA1C) and degree of liver fibrosis in subject with T2DM