Could a noninvasive liver fibrosis marker help identify vascular changes and glycemic patterns in patients with type 2 diabetes mellitus (T2DM)? An exploratory subanalysis of a prospective observational cohort published in the Journal of Diabetes Research found that higher fibrosis-4 (FIB-4) index values were associated with carotid thickening, arterial stiffness, and adverse continuous glucose monitoring (CGM) indices in Japanese patients with T2DM.

The analysis included 887 outpatients with T2DM from a baseline cohort of 999 individuals who underwent CGM. Heavy alcohol consumers were excluded. FIB-4 was calculated, and associations with carotid ultrasound findings, vascular wave velocity tests, and CGM indices were explored.

After adjustment for disease duration, body mass index (BMI), glycated hemoglobin (HbA1c), gamma-glutamyl transferase, and complications, FIB-4 severity category showed significant associations with mean intima-media thickness (IMT), common carotid artery (CCA) maximum IMT, and brachial-ankle pulse wave velocity in ordinal logistic analyses.

Consistent with those findings, FIB-4 was independently associated with mean IMT in multivariable linear regression. Among CGM indices, FIB-4 was positively associated with mean glucose and the standard deviation of mean glucose. FIB-4 was negatively associated with time in range (TIR) and positively associated with time above range (TAR).

The analysis concluded that in Japanese patients with T2DM, FIB-4 is associated with carotid thickening and arterial stiffness, and correlates with the duration of hyperglycemia. Assessment of liver fibrosis in T2DM is imperative, with monitoring of atherosclerosis and cardiovascular diseases in cases of suspected advanced liver fibrosis.