P394 Causes of elevated alanine aminotransferase in Type 2 diabetesCL MORRISON1, TS Purewal2 and PJ Weston21Healthy Prestatyn Iach, Betsi Cadwaladr University Local Health Board, Prestatyn, UK, 2Diabetes Centre, Royal Liverpool Hospital, Liverpool, UKIntroduction: Monitoring liver function tests as part of the diabetes annual review is considered good practice as non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH) can cause few or no symptoms. They are also commonly used to monitor statin therapy, although there is little evidence of systematic hepatotoxity.Method: This study was undertaken in one large primary care centre to examine the causes, prevalence and investigation of deranged liver function tests with elevated levels of alanine aminotransferase (ALT) above 100 IU/l.Results: Of 1,580 with diabetes, 394 (24.9%) had a raised ALT above the reference range, of these 9.4% (37/394) had elevated levels above 100 IU/l, ALT 168.7 IU/l (±64.5,102 to 419) (mean, SD, range) [male 23 (62.2%), age 64.2 years (±13.6, 37 to 94), HbA1c 74.8mmol/mol (±22.9, 41 to 121), body mass index 33kg/m2 (±7.5, 21.8 to 49.8), cholesterol 5.9mmol/l (±1.5, 2.4 to 10.4), triglyceride 3.9mmol/l (±3.9, 0.5 to 21.7), alkaline phosphatase 158.5 IU/l (±104.3, 40 to 561; 45.9% abnormally raised)]. Liver ultrasound identified 13 (35.1%) with NAFLD in whom 9 (69.2%) ALT improved. Six (16.2%) were alcohol dependent, 6 (16.2%) had transient raised ALT due to acute illness, 3 (8.1%) were receiving disease‐modifying anti‐rheumatic drugs and 2 (5.4%) had gastrointestinal malignancy.Conclusion: Abnormal ALT levels are frequently encountered in the diabetes population and existing co‐morbidities or acute illness can contribute to liver dysfunction. NAFLD was caused by poor glycaemic control in the majority of cases but with treatment interventions improved. In the absence of economic studies to support screening for NAFLD, there is no nationally recognised investigation and treatment pathway for abnormal ALTs. This would help improve primary care management and identify those at risk of liver fibrosis or cirrhosis that need onward referral.
Diabetic Medicine – Wiley
Published: Jan 1, 2018
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