AbstractBackground Insulin resistance is associated with metabolic dysfunction-associated steatotic liver disease (MASLD) in the general population, but its relationship with MASLD in people with type 1 diabetes (T1D) remains insufficiently defined. Methods We performed a 40 mU/m2/min hyperinsulinaemic-euglycaemic clamp (HEC) to quantify whole-body glucose disposal (M-value, mg/kg/min). Insulin sensitivity was further assessed using the 13C glucose breath test (13C-GBT) and the estimated glucose disposal rate (eGDR). Liver fat content (LFC) was measured by magnetic resonance spectroscopy, and vibration-controlled transient elastography was performed. Participants were stratified 1:1 by MASLD status based on mean LFC >/≤5.56%. Results We studied 39 adults with T1D (diabetes duration 27±13 years; HbA1c 6.9 6.5-7.8 %). Mean M-value was 4.41±2.37 mg/kg/min. LFC was higher in MASLD versus non-MASLD participants (8.2 6.5-18.7 % vs. 3.0 2.3-3.6 %, p2=0.47). Lower M-value was associated with MASLD (adjusted OR 3.12, 95% CI 1.17-8.37, p=0.024). Both 13C-GBT (aOR 1.54, 95% CI 1.03-2.33, p=0.033) and eGDR (aOR 1.61, 95% CI 1.09-2.38, p=0.016) were also independently associated with MASLD. Conclusion Insulin resistance is independently associated with MASLD in adults with T1D. Impact and implications This study addresses the limited understanding of how MASLD relates to insulin resistance in T1D. We show a robust association between LFC and insulin resistance using gold standard and practical non-invasive measures. These findings may help clinicians identify metabolically at-risk individuals with T1D, although further research is required to clarify whether screening and targeted intervention improve outcomes.
Mertens et al. (Fri,) studied this question.
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