Prevalence of advanced fibrosis risk using FIB-4 in patients with type 2 diabetes and its associated factors: a cross-sectional study in a primary care unit of a university hospital in Southern Thailand.

Abstract

Type 2 diabetes mellitus (T2DM) is a prevalent noncommunicable disease that is strongly associated with metabolic dysfunction-associated steatotic liver disease, a leading cause of cirrhosis and hepatocellular carcinoma. The Fibrosis-4 (FIB-4) index, a noninvasive tool for liver fibrosis assessment, is recommended for all patients with T2DM, yet its use in routine clinical practice remains unclear. We aimed to determine the prevalence of intermediate- and high-risk of advanced liver fibrosis using FIB-4 in patients with T2DM and to identify associated factors. We also assessed documentation of FIB-4 scores and referrals to gastroenterologists in primary care. We conducted a cross-sectional study among patients with T2DM receiving continuous follow-up care in a primary care setting at a university hospital in southern Thailand during 2024. The FIB-4 index was calculated and categorized into low-, intermediate-, and high-risk groups. Binary logistic regression was used to identify factors associated with intermediate-to-high FIB-4 risk level. Among 829 patients, 46.9% were classified as the intermediate-risk and 6.2% as the high-risk groups for having advanced fibrosis. A diabetes duration of ≥ 10 years was significantly associated with intermediate-to-high risk of advanced liver fibrosis [adjusted OR (95% CI) = 2.06 (1.51-2.81)]. Conversely, elevated triglyceride levels, low HDL cholesterol, and obesity were significantly associated with low risk of advanced liver fibrosis [adjusted OR (95% CI) = 0.65 (0.46-0.93), 0.68 (0.51-0.91) and 0.65 (0.49-0.88), respectively]. Imaging in the high-risk group revealed fatty liver in 61.1% and cirrhosis in 22.2%. However, FIB-4 scores were documented in only 1.6% of records, and only 4.1% of intermediate- to high-risk patients were referred to gastroenterology specialists. More than half of the patients with T2DM had a FIB-4 index suggesting increased risk of advanced liver fibrosis, especially those with longer disease duration. Despite this, FIB-4 remains underutilized in primary care, indicating missed opportunities for early detection and intervention.