GA/HbA1c ratio is a simple and practical indicator to evaluate the risk of metabolic dysfunction-associated fatty liver disease in type 2 diabetes: an observational study

Abstract

Background: It is still debatable whether glycated albumin/glycated hemoglobin A1C (GA/HbA1C) ratio is associated with metabolic dysfunction-associated fatty liver disease (MAFLD), and few studies have been conducted in type 2 diabetes mellitus (T2DM). Therefore, we aimed to investigate the association between GA/HbA1C ratio and MAFLD and to evaluate whether GA/HbA1C ratio can be used an indicator of MAFLD in Chinese patients with T2DM.

Methods: This cross-sectional study consisted of 7117 T2DM patients including 3296 men and 3821 women from real-world settings. Abdominal ultrasonography was performed to diagnose MAFLD. In addition to comparing the clinical characteristics among the GA/HbA1C ratio quartile groups, we also investigated the associations of GA/HbA1C ratio and quartiles with MAFLD in T2DM subjects.

Results: There was a significantly decreased trend in the MAFLD prevalence across the GA/HbA1C ratio quartiles (56.3%, 47.4%, 37.8%, and 35.6% for the first, second, third, and fourth quartile, respectively, P < 0.001 for trend) after adjusting for gender, age, and diabetes duration. Fully adjusted Binary logistic regression indicated that both GA/HbA1C ratio (OR: 0.575, 95% CI: 0.471 to 0.702, P < 0.001) and quartiles (P < 0.001 for trend) were inversely associated with the presence of MAFLD among T2DM patients. Additionally, HOMA2-IR values were clearly increased in the T2DM subjects with MAFLD compared with those without MAFLD (P < 0.001), and markedly increased from the highest to the lowest GA/HbA1C ratio quartile (P < 0.001 for trend).

Conclusions: GA/HbA1C ratio is closely and negatively associated with MAFLD in T2DM subjects, which may attribute to that GA/HbA1C ratio reflects the degree of insulin resistance. GA/HbA1C ratio may act as a simple and practical indicator to evaluate the risk of MAFLD in T2DM.

Keywords: GA/HbA1C ratio; Glycated albumin/glycated hemoglobin A1C; Insulin resistance; Metabolic dysfunction-associated fatty liver disease; Non-alcoholic fatty liver disease; Type 2 diabetes mellitus.

Fig. 1

Comparisons of MAFLD prevalence and GA/HbA1C ratio stratified by sex, age, and DD. A Overall prevalence of MAFLD and comparisons of the MAFLD prevalence stratified by gender (P < 0.001). B Comparisons of the MAFLD prevalence stratified by age (P < 0.001 for trend). C Comparisons of the MAFLD prevalence stratified by DD (P < 0.001 for trend). D Overall GA/HbA1C ratio and comparisons of GA/HbA1C ratio stratified by gender (P < 0.001). E Comparisons of GA/HbA1C ratio stratified by age (P < 0.001 for trend). F Comparisons of GA/HbA1C ratio stratified by DD (P < 0.001 for trend)

Fig. 2

Comparisons of GA, HbA1C, and GA/HbA1C ratio. A Comparisons of the MAFLD prevalence across the GA/HbA1C ratio groups (P < 0.001 for trend). B Comparisons of GA/HbA1C ratio between the patients with and without MAFLD (P < 0.001). C Comparisons of GA between the patients with and without MAFLD (P < 0.001). D Comparisons of HbA1C between the patients with and without MAFLD (P < 0.001)

Fig. 3

Comparisons of serum ALT and γ-GT levels. A Comparison of serum ALT levels between the patients with and without MAFLD (P < 0.001). B Comparison of serum ALT levels across the GA/HbA1C ratio quartile groups (P = 0.002 for trend). C Comparison of serum γ-GT levels between the patients with and without MAFLD (P < 0.001). D Comparison of serum γ-GT levels across the GA/HbA1C ratio quartile groups (P < 0.001 for trend)

Fig. 4

Comparisons of HOMA2-IR and HOMA2-S. A Comparison of HOMA2-IR between the patients with and without MAFLD (P < 0.001). B Comparison of HOMA2-IR across the GA/HbA1C ratio quartile groups (P < 0.001  for trend). C Comparison of HOMA2-S between the patients with and without MAFLD (P < 0.001). D Comparison of HOMA2-S across the GA/HbA1C ratio quartile groups (P < 0.001 for trend)