Prevalence of abnormal plasma liver enzymes in older people with Type 2 diabetes

Aims To determine the prevalence and distribution of abnormal plasma liver enzymes in a representative sample of older adults with Type2 diabetes. Methods Plasma concentrations of alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase were measured in a randomly selected, population-based cohort of 1066 men and women aged 60-75years with Type2 diabetes (the Edinburgh Type2 Diabetes Study). Results Overall, 29.1% (95%CI 26.1-31.8) of patients had one or more plasma liver enzymes above the upper limit of the normal reference range. Only 10.1% of these patients had a prior history of liver disease and a further 12.4% reported alcohol intake above recommended limits. Alanine aminotransferase was the most commonly raised liver enzyme (23.1% of patients). The prevalence of abnormal liver enzymes was significantly higher in men (odds ratio1.40, 95%CI 1.07-1.83), in the youngest 5-year age band (odds ratio2.02, 95%CI 1.44-2.84), in patients with diabetes duration <5years (odds ratio1.38, 95%CI 1.01-1.90), plasma HbA _1c≥58mmol/mol (7.5%) (odds ratio1.43, 95%CI 1.09-1.88), obese BMI (odds ratio2.84, 95%CI 1.59-3.06) and secondary care management for their diabetes (odds ratio1.40, 95%CI 1.05-1.87). However, all these factors combined accounted for only 7.6% of the variation in liver enzyme abnormality. Conclusions The prevalence of elevated liver enzymes in people with Type2 diabetes is high, with only modest variation between clinically defined patient groups. Further research is required to determine the prognostic value of raised, routinely measured liver enzymes to inform decisions on appropriate follow-up investigations.