Liver fibrosis risk: a silent threat in type 1 diabetes mellitus.

PURPOSE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized; however, its relevance in individuals with type 1 diabetes mellitus (T1DM) remains unclear. This study aimed to investigate MASLD and its associated determinants in patients with T1DM using multiparametric liver ultrasonography and noninvasive scoring indices. METHODS: This study included 43 patients with T1DM and 43 age-, gender-, and BMI-matched controls. Noninvasive steatosis and fibrosis indices were calculated. Multiparametric liver US, including liver stiffness, attenuation imaging, texture, and hepatorenal index, was used to evaluate steatosis and fibrosis. RESULTS: Steatosis prevalence did not differ between patients with T1DM and controls; however, both FIB-4 index and liver stiffness measurement (LSM) defined risk of liver fibrosis were significantly higher in the T1DM group (11.6% vs. 2.3%). Among patients with T1DM, those with LSM ≥ 8.0 kPa had higher FIB-4 index and hsCRP levels and more frequent retinopathy (p < 0.05). FIB-4 index demonstrated good diagnostic performance for detecting LSM-defined liver fibrosis risk (AUC = 0.86), with an optimal threshold of 0.98. hsCRP levels correlated significantly with LSM (r = 0.410, P = 0.034). CONCLUSIONS: We demonstrated a modest increase in liver fibrosis risk in patients with T1DM compared with controls, independent of steatosis. Lower FIB-4 cut-off values may improve sensitivity for detecting liver fibrosis in T1DM, and higher hsCRP levels in patients with LSM ≥ 8 kPa suggest an possible inflammatory contribution to fibrogenesis, supporting the clinical value of noninvasive fibrosis assessment in T1DM.