Prevalence of elevated hepatic transaminases among upper Egyptian patients with type 2 diabetes mellitus

ABSTRACT

The prevalence of liver transaminases in type 2 diabetics upper Egypt patients with type 2 diabetes is unknown. To estimate the prevalence of elevated liver transaminase levels among upper Egyptian patients with type 2 diabetes and to determine the associated risk factors. We recruited130 patients with type 2 diabetes from the diabetic outpatient clinic of internal medicine department, or those admitted in tropical medicine department, Assiut university hospital. For all participants, the following was recorded; body mass index, waist circumference, lipid profile, and hepatic transaminase levels. HBsAG, anti-HCV and abdominal US examination was done in all patients. Risk factors of raised transaminases were identified using univariate then multivariate analysis. Amoung the 130 patients enrolled in this study. 22.3% [n-29] were males and 77.7% [n=101] were females. The mean age was 47.35 +/- 9.36 years. One hundred and eighteen [90.8%] were obese. The prevalence of elevated AST was 7.7% [n=10] with the gender-wise prevalence of 13.8% [n=4] in men and 5.9% [n=6] in women, p value= 0.157, odds ratio - 0.39 [95% CI 0.103-1.51]. The prevalence of elevated alanine transaminase [ALT] was 11.5% [n=15] with the gender-wise prevalence of 13.8% [n=4] in men, and 10.9% [n=11] in women, p value = 0.441, odds ratio=0.764 [95% confidence interval [CI] 0.224-2.61]. Only 3.8% [n=5] showed elevated levels of both ALT and AST. Patients with high waist circumference had elevated ALT levels [13.8%] versus 4% only in those with normal waist circumference [odds ratio=3.6. 95%, CI 0.462-29.49, and p value = 0.035]. Insulin use was associated with a high odds ratio for elevated ALT levels [OR=18.85. CI 2.39-148.3]. High ALT levels were significantly associated with the duration of diabetes 14.85% in those with DM dating to <10 years versus 0% in those with DM dating to >/= 10 [odds ratio= 0.748.CI 0.673-0.832 and p value=0.018]. Younger patients [less than 45 old] and a higher tendency to have elevated ALT compared to those over 45 years [OR= 1.19. p value=0.003]. on multivariate analysis. Young age and insulin use was only independent predictor for isolated rise in ALT or AST were obese [P value= 00.043 and 0.045 respectively]. The risk factors for elevated levels of both ALT and AST in univariate analysis were male gender. Patients less than 45 years old and insulin use. Elevated ALT and AST levels are found in 11.5% and 7.7% of type 2 diabetic patients re-spectively. Elevated ALT level is observed more in relatively younger diabetic patients with isolated rise of either ALT or AST were obese. One multivariate analysis, young age and insulin use were only independent predictor for isolated rise in ALT levels. Hyperinsulinemia and insulin resistance should be considered as the key mechanism leading to hepatic steatosis