SAT-603 - Targeted Liver Fibrosis Assessment in Patient with Metabolic Dysfunction

Metabolic dysfunction-associated steatotic liver disease (MASLD), formally known as nonalcoholic fatty liver disease, is the leading cause of chronic liver disease with an estimated global prevalence greater than 25% and greater than 70% in those with diabetes. Societal guidelines including the American Association for the Study of Liver Diseases (AASLD) and the American Diabetes Association (ADA) recommend targeted screening for clinically significant liver fibrosis for all patients with type 2 diabetes mellitus (T2DM) or with two or more other metabolic risk factors. Patients at high risk for MASLD remain largely unaware of the disease, and many primary care physicians feel uncertain regarding which tests to order, how to interpret them, and when to refer to hepatology during the evaluation of liver fibrosis. This study's main goal is to identify the care gap that exists between the number of patients in primary care clinics that should have been screened for MASLD based on their risk factors and the number of those patients that received recommended screening. Once identified, liver fibrosis screening will be implemented into the clinical workflow of primary care physicians and endocrinologists to help close the care gap.
Patients from a primary care clinic with T2DM were screened excluding patients with existing liver, hematologic, or oncologic pathology. Primary risk assessment was done by calculation of a Fibrosis-4 (FIB-4) score using the patients age, aspartate aminotransferase (AST), alanine transaminase (ALT), and platelet count using the following formula FIB-4=(Age×AST) ÷ (Platelet Count×√ALT).
2852 patients with T2DM were identified with a mean age of 58 (19-94), mean A1c of 7.4% (4.1-15.9), and a mean BMI of 37.1kg/m2 (30-87.9). Of these patients 2135 had sufficient data to calculate the FIB-4 score. Based on the score, patients are grouped by risk level; 51.4% were low risk ( < 1.3), 19.8% intermediate risk (1.3-2.6), and 3.6% high risk (>2.6). Secondary risk assessment is recommended for anyone with a non-low FIB-4 score and is typically completed via vibration-controlled transient elastography (VCTE), a special type of ultrasound used to measure liver stiffness. Hepatology referral is recommended for all patients with a high FIB-4 score or intermediate/high risk level based on secondary risk assessment. It was found that 23.5% of patients with MASLD risk factors had a non-low FIB-4 score and thus further screening was recommended. However, less than 3% of these patients had undergone elastography screening.
This shows that there is a large care gap in diagnosing and treating MASLD in T2DM patients. Thus, more effective strategies need to be adopted to implement ADA standard of care institution wide, not just initial screening, but follow up on abnormal results with appropriate workup and treatment.

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