Abstract
BACKGROUND: Children and adolescents with type 1 diabetes mellitus (T1DM) occasionally develop liver disorders. Glycogenic hepatopathy and non-alcoholic fatty liver disease are the most common conditions found in patients with poor glycemic control. The main purpose of the study was to determine the frequency of liver disorders in children and adolescents with T1DM and to investigate a correlation with chronic complications or associated autoimmune diseases. The second aim was to investigate if glycogenic hepatopathy and non-alcoholic fatty liver disease could be differentiated non-invasively with MRI among patients with T1DM. METHODS: In 154 patients with T1DM age 2-20 years, clinical exam, laboratory tests and abdominal ultrasound were performed. Liver MRI and biopsy were performed in selected patients. RESULTS: Over the study period, 154 patients with T1DM were investigated (77 females and 77 males, ages 2-20, mean 14.2 ± 3.2 years, T1DM duration 1-18 years, mean 7.7 ± 4.1 years, BMI 20.6 ± 3.7 kg/m(2)). Intensive therapy with insulin analogues was used in 121 (78.6%), and 33 patients (21.4%) were treated via insulin pumps. We did not observe delayed puberty. We have found hepatomegaly in 9.7% patients, elevated transaminases in 18.8%, ultrasound-enlarged liver in 21.7% and 27.3% with abnormal echogenicity. MRI and liver biopsy were performed in 9 patients. A liver biopsy revealed 8 patients with glycogenic hepatopathy and only one with non-alcoholic fatty liver disease. MRI showed a good association with pathohistological findings (P < 0.001). We did not establish a correlation between hepatic complications and chronic complications or associated autoimmune diseases. CONCLUSION: Liver disorders in patients with T1DM are not as rare as previously thought, and glycogenic hepatopathy is the most common. A combination of liver enzymes and a liver ultrasound exam is a good initial screening and follow-up method for the evaluation of liver disorders. MRI represents a good non-invasive tool for the distinction between glycogen and fat accumulation, and might postpone liver biopsy beyond initial workup.