Concomitant screening for liver fibrosis and steatosis in French type 2 diabetic patients using Fibroscan.

BACKGROUND: Type 2 diabetes is a risk factor for steatohepatitis and fibrosis. Non-invasive liver stiffness (LS) and controlled attenuation parameter (CAP) measurements by Fibroscan allow assessing liver fat and fibrosis. AIM: To determine the prevalence of steatosis and significant fibrosis in a community-based diabetic population. METHODS: LS and CAP were measured in 705 patients using the standard "M probe." A second "XL probe" was used, without CAP measurement, in case of failure with the "M probe." RESULTS: LS and CAP measurements were obtained in 437 patients (the M group), LS measurements (LSM) with the XL probe being available in additional 232 patients. After the combined use of both probes, LSM failure and unreliable result were 1.6% and 5.6% respectively. Overall, 12.7% (n=85), 7.3% and 2.1% exhibited significant or advanced fibrosis or cirrhosis (LSM≥8 kPa, ≥9.6 kPa, ≥13 kPa respectively), half of the patients with LSM≥8 kPa displayed normal liver tests. Significant and severe steatosis were measured in 75% and 24% of the M group patients. By multivariate analysis, factors associated with severe fibrosis were age, overweight, high GGT. Forty-seven patients with LSM≥8 kPa underwent liver biopsy; 93% had steatosis and 51% severe fibrosis. A significant correlation was found between LSM values and fibrosis score with an accuracy rate of 83%, 68% and 83% for LSM≥8 kPa, ≥9.6 kPa and ≥13 kPa respectively. CONCLUSIONS: The prevalence of significant steatosis is very high and significant fibrosis affect 12.7% of the patients. Fibroscan is an effective procedure to screen for fibrosis and steatosis in diabetic patients.

Socioeconomic deprivation remains a significant barrier in the choice of bariatric surgery even when full medical expense coverage is present.

BACKGROUND: The prevalence of obesity is increasing in the socioeconomically deprived sector of the French population. OBJECTIVES: Our objective was to assess whether the presence of a socioeconomic gradient could affect access to bariatric surgery in a publicly funded healthcare system with full medical expense coverage. SETTING: The study was conducted at a general hospital and a health examination center. METHODS: We prospectively included 100 patients who were admitted to the hospital for a preoperative bariatric surgery evaluation. As a reference group, we included 578 patients from the same area with body mass index (BMI) values≥35 kg/m² who visited the health center for regular medical, cardiovascular checkups. The patients were required to complete the Evaluation of Precariousness and Health Inequalities in Health Examination Centers (EPICES) questionnaire to investigate deprivation (deprivation cutoff≥30.17). RESULTS: A total of 94 patients had complete data, with a mean EPICES score of 37.7±19.1 (P<.001). Patients were younger (mean age 39.2±12.7 years, P<.001), had a stronger female predominance (87%, P = .030), and higher mean BMI (43.3±6.9 kg/m², P<.001) than the reference group and were less socioeconomically deprived (64% versus 82% in the reference group, P<.001). No significant correlations existed among BMI, participant age, and deprivation score. In a subsequent age- and BMI-matched analysis, bariatric surgery candidates exhibited lower levels of deprivation. CONCLUSIONS: The presence not only of material (e.g., coverage for medical expenses) but also social support is an important step toward the acceptance of bariatric surgery by morbidly obese patients.