Association of Nonalcoholic Fatty Liver Disease with Insulin Resistance in Type 2 Diabetes Mellitus – A Prospective Study

Research Article

J Fam Med. 2017; 4(4): 1119.

Association of Nonalcoholic Fatty Liver Disease with Insulin Resistance in Type 2 Diabetes Mellitus – A Prospective Study

Jalal MJA¹*, Nisha N², Basheer S², Joseph N² and Shobha P²

¹Department of Internal Medicine and Rheumatology, VPS Lakeshore Hospital, Kochi, Kerala, India

²Specialist, Department of Family Medicine, VPS Lakeshore Hospital, Kochi, Kerala, India

*Corresponding author: Jalal MJA, Department of Internal Medicine and Rheumatology, VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India

Received: May 13, 2017; Accepted: June 08, 2017; Published: June 15, 2017


Background: Association of Nonalcoholic fatty liver disease (NAFLD) with type 2 diabetes mellitus (T2DM) is common. Our aim was to study the association of NAFLD with Insulin Resistance in T2DM patients.

Materials and Methods: Our study population included 100 patients of T2DM attending the medical out patient department of a Tertiary care center in Kochi. Presence of fatty liver in these patients was determined by abdominal sonography. Insulin Resistance was assessed by Homeostasis Model Assistant – Insulin Resistance (HOMA–IR). P–value less than 0.05 was considered statistically significant.

Results: The study group (n = 100) was divided into a NAFLD group (n = 45) and a non–NAFLD group (n = 55). The prevalence of NAFLD in our study was 45%. The prevalence of obesity (measured by BMI), central obesity (measured by waist circumference and waist hip ratio) was higher in NAFLD group with increased values of HbA1c and triglyceride levels. Insulin Resistance was significantly higher in NAFLD group than Non NAFLD group (P value 0.02, 0.02).

Conclusion: The prevalence of NAFLD is high in patients of Type 2 DM. Presence of NAFLD among T2DM patients is significantly associated with Insulin resistance.

Keywords: NAFLD; Insulin Resistance; Type 2 diabetes mellitus


Nonalcoholic fatty liver disease (NAFLD) is a pandemic worldwide. NAFLD denotes a spectrum of changes occurring in the liver of non–alcoholic individuals. It is an emerging chronic liver disease [1]. Macrovesicular hepatic steatosis is the characteristic histological finding. NAFLD co–exists with features of the metabolic syndrome including obesity, type 2 diabetes mellitus [T2DM], dyslipidemia and hypertension. Hyperinsulinemia and increased free fatty acid delivery to the liver contributes to the pathophysiology of NAFLD [2]. NAFLD in T2DM increases the rates of cirrhosis and mortality and hence have a poor prognosis [3].

Materials and Methods

Our study was carried out in the Departments of Internal Medicine and Family Medicine, VPS Lakeshore Hospital, Kochi from January 2015 to October 2016. Initial screening was carried out to include/exclude the patients based on history taking and clinical examination. A total of 100 patients with age more than 18 years were included who were having diabetes of minimum 1–year duration. Patients who consumed alcohol, patients with other liver diseases such as malignancies, hepatitis, liver abscesses, and patients with deranged hepatic functions due to any other febrile illnesses/disease were excluded from the study.

A detailed history regarding the disease was taken, and complete physical examination was performed. Obesity was calculated with BMI [body mass index], whereas waist/hip ratio was measured as an index of splanchnic fat accumulation. After an overnight fast, serum samples were obtained from all subjects for liver function tests (aminotransferases and alkaline phosphates), fasting lipid profile (total cholesterol, triglycerides, lipoproteins), fasting blood glucose (FBS), HbA1C, and fasting insulin levels.

Homeostasis Model Assistant–Insulin Resistance (HOMAIR) was calculated as measure of insulin resistance using following formula:

HOMA–IR= [fasting insulin (μU/ml) ×fasting glucose (mmol/l)]/22.5

Presence of fatty liver was determined by abdominal ultrasonography findings (diffuse increase in echogenicity as compared to that of the spleen or renal cortex). Patients were categorized as those with NALFD and those without NALFD. Statistical analysis was carried out for study parameters between the two groups (NAFLD and non–NAFLD) using student’s t–test. P < 0.05 was considered significant.


The mean age of the patient was 55.02 years. Out of 100 patients, 47 (47%) were males and 53 (53%) were females. None of the subjects had history of alcohol consumption. Of 100 patients with T2DM, 55 (55%) were found to have changes of fatty liver disease in abdominal ultrasonography examination. 32 males (32%) and 33 females (33%) had fatty liver disease. Elevated ALT (>40 IU/dl) was seen in 10 patients (10%) while 5 patients (5%) had AST >40 IU/dl (Table 1). Mean BMI was 28.12 kg/m² (17.2–37.05) (Table 1). BMI, waist/hip ratio, S. triglyceride level were significantly high (Table 2) in NAFLD group as compared to Non–NAFLD group (P = 0.009, 0.0002, 0.003, respectively). Quantitative measures of insulin resistance – S. fasting insulin, HOMA–IR score showed significant association of NAFLD with increased insulin resistance.

Citation:Jalal MJA, Nisha N, Basheer S, Joseph N and Shobha P. Association of Nonalcoholic Fatty Liver Disease with Insulin Resistance in Type 2 Diabetes Mellitus – A Prospective Study. J Fam Med. 2017; 4(4): 1119. ISSN:2380-0658