ObjectiveTo evaluate the clinical characteristics and influencing factors in patients with type 2 diabetes mellitus (T2DM) and metabolic associated fatty liver disease(MAFLD) complicated by medium-high risk metabolic associated fatty liver fibrosis.Methods495 patients with T2DM combined with MAFLD who attended the Department of Endocrinology of the Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, from August 2022 to May 2024 were retrospectively selected, and the patients were divided into low-risk of metabolic associated fatty liver fibrosis group (abbreviated hereafter as low-risk group, n=311) and medium-high risk of metabolic associated fatty liver fibrosis group (abbreviated hereafter as medium-high risk group, n=184). Clinical information and laboratory results were collected from the two groups of patients, and the factors influencing the risk of medium-high risk of metabolic associated fatty liver fibrosis were analyzed using univariate and multivariate binary logistic regression in patients with T2DM and MAFLD. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were plotted to evaluate the predictive value of these factors for medium-high risk metabolic associated fatty liver fibrosis occurrence in patients with T2DM and MAFLD.ResultsAge, percentage of patients with history of hypertension, percentage of patients with history of coronary heart disease, aspartate aminotransferase (AST), blood urea nitrogen (BUN), and creatinine (Cr) were higher in medium-high risk group (P<0.05), and percentage of male patients, platelet count (PLT), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), hemoglobin (HbA_1c), free triiodothyronine (FT₃), free thyroxine (FT₄), and thyroid feedback quantile based index(TFQI) were lower (P<0.05). Univariate binary logistic regression analysis revealed that male (OR=0.642, 95%CI 0.443-0.932, P=0.020), HbA_1c (OR=0.899, 95%CI 0.826-0.979, P=0.014), BUN (OR=1.313, 95%CI 1.163-1.482, P<0.001), Cr (OR=1.019, 95%CI 1.008-1.030, P<0.001), TC (OR=0.742, 95%CI 0.625-0.880, P=0.001), LDL-C (OR=0.632, 95%CI 0.521-0.766, P<0.001), FT₃ (OR=0.464, 95%CI 0.339-0.636, P<0.001), FT₄ (OR=0.848, 95%CI 0.774-0.930, P<0.001), TFQI (OR=0.598, 95%CI 0.367-0.598, P=0.039) are factors of medium-high risk metabolic associated fatty liver fibrosis in patients with T2DM and MAFLD. Multivariate binary logistic regression analysis revealed that BUN (OR=1.165, 95%CI 1.006-1.348, P=0.042) and Cr (OR=1.020, 95%CI 1.005-1.036, P=0.008) were independent risk factors for medium-high risk metabolic associated fatty liver fibrosis in patients with T2DM and MAFLD. In contrast, male sex (OR=0.574, 95%CI 0.339-0.972, P=0.039), LDL-C (OR=0.659, 95%CI 0.483-0.898, P=0.008), FT₃ (OR=0.590, 95%CI 0.404-0.864, P=0.007), and FT₄ (OR=0.863, 95%CI 0.762-0.977, P=0.020) were identified as independent protective factors against medium-high risk metabolic associated fatty liver fibrosis in patients with T2DM and MAFLD. The combined predictive model using these six factors showed an area under the ROC curve of 0.728(95%CI 0.682-0.774), with a sensitivity of 0.620 and a specificity of 0.759 for predicting medium-high risk metabolic associated fatty liver fibrosis in patients with T2DM and MAFLD.ConclusionsGender, BUN, Cr, LDL-C, FT₃, and FT₄ are independent influences of medium-high risk of metabolic associated fatty liver fibrosis in patients with T2DM and MAFLD, and the monitoring of the above abnormal biochemical indexes and early interventions are beneficial in delaying the development of hepatic fibrosis in patients with T2DM and MAFLD.

diabetes mellitus, type 2;metabolic associated fatty liver disease;metabolic associated fatty liver fibrosis