Risk Stratification and Referral Patterns for Metabolic Liver Disease in Type 2 Diabetes: Real-World FIB-4 Utilization
https://doi.org/10.15605/jafes.041.S1
- Author:
Calven Fu Hao Lim
1
;
Min Chow
1
;
Jess Jie Ying Ng
1
Author Information
1. Gastroenterology and Hepatology Unit, Department of Medicine, Universiti Malaya
- Publication Type:Journal Article
- MeSH:
Diabetes Mellitus, Type 2;
Risk Assessment;
Liver Diseases;
Referral and Consultation
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):38-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Metabolic dysfunction–associated steatotic liver disease
(MASLD) is common among patients with type 2 diabetes
(T2D) and increases the risk of cirrhosis, yet fibrosis often
remains clinically silent until hepatic decompensation
occurs. Current diabetes guidelines recommend noninvasive fibrosis risk stratification, such as the fibrosis-4
index (FIB-4), during routine diabetes care, but real-world
adoption remains unclear. This study aimed to evaluate
the implementation of FIB-4 as a risk stratification tool in
patients with T2D.
Methodology:This was a retrospective study of consecutive patients with
T2D who were seen in the Diabetes Clinic of University of
Malaya Medical Centre in 2023. Patients were identified as
having a higher risk of future cirrhosis based on elevated
FIB-4 ≥1.3.
Results:The data for 1,009 patients were analyzed, median age
62 (52–71) years, 40.7% male. Elevated FIB-4 was seen in
28.8% (291/1,009). Only 12.0% (35/291) with elevated FIB-4
were referred for further hepatology evaluation, whereas
3.3% (24/718) with low FIB-4 were referred. Among the
patients with elevated FIB-4, those referred were more
likely known to have hepatic steatosis, had higher alanine
aminotransferase, aspartate aminotransferase, gammaglutamyl transferase, and lower low-density lipoprotein cholesterol and platelet count. Over a median follow-up of
1.71 (0.99–1.95) years, totaling 1,440 person-years, two liverrelated events (0.2%) occurred (one each in the elevated
and low FIB-4 group, respectively). Sixteen patients (4.0%)
experienced cardiovascular events, including one patient
(0.6%) in the elevated FIB-4 group and 15 (2.9%) in the low
FIB-4 group.
Conclusion:Despite automated FIB-4 reporting, this risk stratification
tool was underutilized in T2D, resulting in missed
opportunities for early identification and management of
more severe liver disease. Integration of FIB-4 into diabetes
care workflows, alongside structured referral pathways
and clinician education, may improve early detection and
reduce long-term hepatic complications in T2D.
- Full text:2026072908451818595EP_A035.pdf
