Correlation of Glycemic Control with Liver Fibrosis Risk (FIB-4) in Patients with Type-2 Diabetes Mellitus

Abstract

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and is a major risk factor for progressive liver fibrosis. Poor glycemic control may accelerate fibrogenesis, which can be assessed non-invasively using the Fibrosis-4 (FIB-4) index.

Objective: To evaluate the association between glycemic control, measured by glycated hemoglobin (HbA1c), and liver fibrosis risk as estimated by the FIB-4 score in patients with T2DM.

Methodology: This cross-sectional study included 60 adults with T2DM attending a tertiary care diabetes clinic between January 2023 and December 2024. Glycemic control was assessed using HbA1c. Liver fibrosis risk was estimated using the FIB-4 index and categorized as low (<1.3), intermediate (1.3–2.67), or high (>2.67). Differences in HbA1c across FIB-4 categories were analyzed using one-way ANOVA. Pearson correlation was used to assess the relationship between HbA1c and FIB-4 score.

Results: The mean age was 54.1 ± 9.3 years, and 55% of participants were male. Mean HbA1c was 8.4 ± 1.6%. FIB-4 risk categories were low in 46.7%, intermediate in 36.7%, and high in 16.7% of patients. HbA1c increased significantly across fibrosis categories (low: 7.6 ± 1.1%, intermediate: 8.6 ± 1.3%, high: 9.7 ± 1.4%; p < 0.001). A moderate to strong positive correlation was observed between HbA1c and FIB-4 score (r = 0.61, p < 0.001).

Conclusion: Poor glycemic control is significantly associated with higher FIB-4 scores, indicating increased risk of advanced fibrosis in patients with T2DM. Incorporation of FIB-4 assessment into routine diabetes care may facilitate early identification of patients at risk for progressive MASLD.