Glycogenic hepatopathy associated with hepatic steatosis in type 1 diabetes Short title: GH associated with MAFLD in T1DM

Abstract

Abstract Purpose: Glycogenic hepatopathy is associated with significant psychosocial consequences and health costs. Metabolic Dysfunction-Associated Steatotic Liver Disease and glycogenic hepatopathy are frequently confused as “fatty liver” when seen on ultrasonography. We wished to examine liver fat and glycogen content in groups defined based on metabolic and liver disease phenotypes. Methods: This case-control study undertaken in a tertiary hospital used nuclear proton magnetic resonance spectroscopy to examine liver fat and glycogen content in five clinical groups, each containing five participants: 1. type 1 diabetes with glycogenic hepatopathy, 2. satisfactorily controlled type 1 diabetes with no liver disease, 3. poorly controlled type 1 diabetes without liver disease, 4. a control group of body mass index- and age-matched individuals without diabetes or liver disease, and 5. hepatic steatosis. Results: Fat content was highest in the hepatic steatosis (median 15.4%, IQR 10.0-19.3) and glycogenic hepatopathy (median 6.5%, IQR 4.5–9.1) groups and compared to both of these groups was lower in the control group (median 1.0%, IQR 0.7–1.1, p 0.002 and 0.022), the T1DM group with satisfactory control (median 0.3%, IQR 0.2–0.6, p < 0.001 and < 0.001), and the T1DM group with poor control without liver disease (median 1.1%, IQR 0.9–1.1, p 0.001 and 0.012). Conclusions: The hyperechoic ultrasonographic liver changes seen in type 1 diabetes mellitus are often termed “fatty liver”, but may relate to glycogen accumulation and not fat. In cases diagnosed with glycogenic hepatopathy there may be significant concomitant fat accumulation, compounding the already elevated cardiovascular risk in this cohort.