Key result
Upper tertiles of ALT and GGT predicted the development of early cardiac autonomic nerve dysfunction in adolescents with type 1 diabetes (OR 2.05, 95% CI 1.20-3.48 for ALT).
Why the study?
Data on the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on diabetes complications in youth with type 1 diabetes were lacking.
Do higher ALT and GGT levels predict early cardiac autonomic nerve dysfunction in adolescents with type 1 diabetes?
Cohort (n=102)
Do higher ALT and GGT levels predict early cardiac autonomic nerve dysfunction in adolescents with type 1 diabetes?
Odds Ratio: 2.05 (95% CI 1.2–3.48)
Higher liver enzymes (ALT and GGT) are associated with the development of early cardiac autonomic neuropathy in adolescents with type 1 diabetes, suggesting a link between hepatic inflammation and systemic endothelial dysfunction.
MAFLD may flag higher complication risk in T1D youth; leaves open whether screening or intervention modifies outcomes.
Aim: Data on the impact of metabolic dysfunction‐associated fatty liver disease (MAFLD) on diabetes complications in youth with type 1 diabetes are lacking. However, MAFLD is well known to contribute to cardiovascular disease (CVD) in people with type 2 diabetes. We aimed to investigate markers of MAFLD in youth with type 1 diabetes and their relationship with chronic complications. Methods: A prospective study of 102 adolescents (mean age 14.7 ± 1.9 years) with type 1 diabetes underwent repeated annual diabetes complications assessments, including annual measures of liver enzymes. Early cardiac autonomic nerve dysfunction (CAN) was defined as ≥1 abnormality in seven heart rate variability parameters derived from a 10‐min resting electrocardiogram. Multivariate generalized estimating equations explored predictors of CAN and other microvascular complications (retinopathy and early kidney dysfunction). Results: After a median follow‐up of 3.5 years (IQR 2.7–4.6), there were significant increases in the mean alanine transaminase level (ALT) and systolic blood pressure (SBP) percentiles. Upper ALT and gamma‐glutamyl transferase (GGT) tertiles (T3 vs. T1‐2: odds ratio [OR], 95% confidence interval [CI], 2.05 [1.20, 3.48], and 2.99 [1.61, 5.58], respectively) predicted CAN development (23%, n = 24) independent of HbA1c and diabetes duration. They were not associated with retinopathy or early kidney dysfunction. Conclusion: Higher ALT and GGT associate with early CAN in adolescents with type 1 diabetes, suggesting hepatic inflammation may compound the impact of the diabetes milieu on systemic endothelial dysfunction.
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Velayutham et al. (2025) conducted a cohort in Type 1 diabetes (n=102). Upper ALT and GGT tertiles vs. Lower tertiles (T1-2) was evaluated on Early cardiac autonomic nerve dysfunction (CAN) (OR 2.05, 95% CI 1.20-3.48). Upper tertiles of ALT and GGT predicted the development of early cardiac autonomic nerve dysfunction in adolescents with type 1 diabetes (OR 2.05, 95% CI 1.20-3.48 for ALT).
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