NAFLD may raise risk for severe hypoglycemia in T2DM

Nonalcoholic fatty liver disease (NAFLD) is associated with a higher risk for severe hypoglycemia in patients with type 2 diabetes, according to a study published online Feb. 23 in JAMA Network Open.

Ji-Yeon Lee, M.D., Ph.D., from Yonsei University College of Medicine in Seoul, South Korea, and colleagues explored the association of NAFLD with severe hypoglycemia among patients with type 2 diabetes. The analysis included 1.9 million individuals (aged 20 years or older) who had a medical examination from January 2009 through December 2012, with follow-up through 2015.

• The researchers found that 2.3% of individuals experienced one or more severe hypoglycemia events, and those with severe hypoglycemia were older (mean age, 67.9 versus 57.2 years) and had lower mean body mass index (24.2 versus 25.1) versus those without severe hypoglycemia.
• When adjusting for multiple clinical factors, including body mass index, there was a J-shaped association noted between the fatty liver index and severe hypoglycemia (5th decile: adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.83 to 0.90; 9th decile: aHR, 1.02; 95% CI, 0.96 to 1.08; 10th decile: aHR, 1.29; 95% CI, 1.22 to 1.37).
• The estimated risk for hypoglycemia was higher in participants with NAFLD (aHR, 1.26; 95% CI, 1.22 to 1.30), and the association was more prominent in female participants (aHR, 1.29; 95% CI, 1.23 to 1.36) and those with underweight (aHR, 1.71; 95% CI, 1.02 to 2.88).

"Presence of NAFLD should be considered when evaluating vulnerability to hypoglycemia in patients with type 2 diabetes," the authors write.

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