Type 2 diabetes

Background: The coexistence of type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) accelerates the progression of cardiovascular and metabolic disorders. To mitigate the medical and economic burden associated with these comorbidities, identifying their risk factors is essential. Aim: to assess the prevalence of MASLD and identify its associated risk factors in T2D patients in Tunisia. Methods: This descriptive and analytical study included 202 T2D patients followed over a 12-year period at the Endocrinology Department in Sfax, Tunisia. Patients were divided into two groups: 101 patients with confirmed MASLD (G1) and 101 patients without MASLD (G2). Results: The prevalence of MASLD was 17.03%. A family history of autoimmunity was significantly associated with MASLD. Glycemic control indicators, including HbA1C levels (p=0.943) and blood glucose levels (p=0.627), did not differ between groups. Insulin therapy was significantly less common in G1 (p=0.027). Abdominal obesity and elevated triglyceride levels were strongly associated with MASLD. Additionally, carbohydrate intake was higher in G1 compared to G2 (p=0.041). Multivariate analysis identified non-HDL cholesterol as the most significant independent risk factor for MASLD (odds ratio [OR]: 4.07 × 10⁵), followed by uric acid levels (OR: 1.03, p=0.024) in a 95% confidence interval of [1.004–1.058]. Conclusion: The findings reveal a notable prevalence of MASLD among T2D patients in Tunisia, with non-HDL cholesterol, uric acid levels, abdominal obesity, and dietary patterns emerging as key contributors. These results emphasize the need for targeted screening and management strategies of MASLD.

New biomarkers are currently promising to improve cardiovascular risk (CVR) prediction to prevent cardiovascular complications and their associated morbidity and mortality. In practice, homocysteine (Hcy) and vitamin D (Vit D) have shown statistical associations with the incidence of cardiovascular events. Our study aimed to investigate the association between each of these biomarkers and atherosclerosis and to evaluate their contribution to the stratification of CVR in type 2 diabetic patients (T2D). Methods: This was a cross-sectional and comparative study that included 53 T2D patients with at least one cardiovascular disease (CVD) and 67 T2D patients without any CVD. Measurements of Hcy and 25-OH Vit D were obtained for 116 and 71 patients, respectively. Hyperhomocysteinemia (HHC) was defined as a level greater than 15 μmol/L, and Vit D deficiency was defined as a level below 10 ng/mL. Results: The average level of Hcy was 27.65 ± 31.95 μmol/L. It was significantly correlated with age (p = 0.008), body mass index (p = 0.008), fasting blood glucose (p Conclusion: Our study demonstrated an association between Hcy, macroangiopathy, and coronary artery disease in T2D patients; however, Vit D was not effective in diagnosing these conditions.