Multidisciplinary intensive lifestyle intervention improves markers of nonalcoholic fatty liver disease (NAFLD) in patients with type 1 diabetes and obesity: a retrospective matched-cohort study

Shaheen Tomah; Tareq Salah; Marwa Al-Badri; Shilton Dhaver; Hannah Gardner; Mhd Wael Tasabehji; Osama Hamdy

doi:10.1186/s40842-023-00150-9

Multidisciplinary intensive lifestyle intervention improves markers of nonalcoholic fatty liver disease (NAFLD) in patients with type 1 diabetes and obesity: a retrospective matched-cohort study

Clin Diabetes Endocrinol. 2023 Apr 12;9(1):3. doi: 10.1186/s40842-023-00150-9.

Authors

Shaheen Tomah^#^{1

2}, Tareq Salah^#^{3

4}, Marwa Al-Badri^{1

2}, Shilton Dhaver¹, Hannah Gardner¹, Mhd Wael Tasabehji^{1

2}, Osama Hamdy^{1

2}

Affiliations

¹ Joslin Diabetes Center, Boston, MA, 02215, USA.
² Harvard Medical School, Boston, MA, 02215, USA.
³ Joslin Diabetes Center, Boston, MA, 02215, USA. tareq.salah@joslin.harvard.edu.
⁴ Harvard Medical School, Boston, MA, 02215, USA. tareq.salah@joslin.harvard.edu.

^# Contributed equally.

Abstract

Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing among patients with type 1 diabetes (T1D) paralleling the increasing prevalence of obesity among this population. However, little is known about the impact of intensive lifestyle intervention (ILI) on NAFLD in patients with T1D.

Methods: Using Hepatic Steatosis Index (HSI), a noninvasive surrogate predictor of NAFLD, we retrospectively evaluated 88 adult patients with T1D and obesity after one year of participating in a 12-week ILI program in real-world clinical practice. Using the NAFLD guidelines of the American Association for the Study of Liver Diseases (AASLD), we excluded 11 participants. We matched the remaining ILI cohort (age 43 ± 12 years, females 65%, diabetes duration 22 ± 9 years, A1C 8.2 ± 0.9%, body weight 101 ± 17 kg, BMI 35.3 ± 4.9 kg/m²) in 1:1 ratio with a similar cohort of patients with T1D and obesity who received standard diabetes care (SC) at the same practice and during the same period. Matching criteria included: sex, age, BMI, A1C and duration of T1D. HSI [8 + ALT/AST + BMI (+ 2 if female, + 2 if T2D)] was calculated at baseline and after 12 months of intervention.

Results: At baseline, HSI was similar between the two cohorts (46.2 ± 6.1 in the ILI cohort and 44.9 ± 5.7 in the SC cohort). After 12 months, the ILI group lost an average of 5.6 ± 2.7 kg (5.8%, p < 0.05) while the SC group maintained their baseline body weight (p < 0.001 between groups). HSI decreased significantly from baseline in the ILI group (-2.7 ± 1.1, p = 0.01), but did not change in the SC group (0.6 ± 0.9, p = 0.53, p < 0.001 between groups). Percentage of patients with high likelihood of NAFLD diagnosis decreased from 100% at baseline to 88.3% in the ILI group, and was 10.4% less compared to SC (p < 0.01). Total daily insulin dose decreased in the ILI cohort compared to the SC cohort (-6.1 ± 4.2 versus 1.34 ± 4.3 units/day, p < 0.01).

Conclusions: Twelve weeks of ILI improved HSI and decreased total daily insulin requirements in patients with T1D and obesity at one year. Short-term ILI should be implemented in the management of NAFLD for obese patients with type 1 diabetes.

Keywords: Lifestyle intervention; Liver fibrosis; NAFLD; Obesity; Type 1 Diabetes; Weight management.