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A Telltale Sign of Type 2 Diabetes

Aug 7, 2015

Elevated serum liver markers may be disease indicator….

Type 2 diabetes and liver disease seem to have a connection; the liver is one of the targets of some common diabetic medications. The body needs the liver to help maintain normal glucose levels. But when the cells in the body become resistant to insulin, the liver produces more and more glucose and tends to get overworked, eventually no longer working properly. Insulin resistance that leads to liver dysfunction usually results in type 2 diabetes. In this study, researchers investigated the possible link between certain disease states or abnormalities (abnormal fasting glucose levels, cardiovascular disease, metabolic syndrome, type 2 diabetes) and elevated liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], gamma-glutamyltransferase [GGT]). Although there is some evidence that lead researchers to believe that the detection of elevated liver enzymes is a reliable sign that these individuals are at a higher risk for developing type 2 diabetes, they would like to identify which enzyme is the best indicator and which increases the prevalence of type 2 diabetes.


There were 8,863 study participants, all of which were over the age of 30, with no history of malignancy, hepatitis B or C, or liver cirrhosis. None of the participants were pregnant or consumed more than 30 grams of alcohol per day. There were 3,408 men and 5,455 women who participated in the study. Liver enzymes and their correlation with type 2 diabetes were evaluated utilizing logistic regression models. Based on liver marker levels and gender, individuals were placed into specific quartiles.

Liver marker combinations revealed that individuals who had at least two liver enzymes levels in the highest quartile were at a higher risk for type 2 diabetes and impaired fasting glucose. The highest risk of type 2 diabetes for men was 3.21 (95% CI: 1.829-5.622, p<0.001) and 4.60 (95% CI: 3.217-6.582, p<0.001) for women. The highest risk of impaired fasting glucose was 1.99 for men and 2.40 for women.

Researchers found that elevated levels of ALT and GGT (positive correlation) and the lowest levels of AST/ALT (negative correlation) are associated with a higher prevalence for type 2 diabetes and prediabetes. ALT levels seem to be the most predictive of type 2 diabetes in women. Overall, the results of this study support the theory that liver enzymes can be used as a biomarker for type 2 diabetes.

Practice Pearls:

  • Serum ALT, AST, and GGT are easily accessible and can be used to provide an easy and predictive measure for evaluating an individual’s risk for type 2 diabetes and prediabetes.
  • Elevated ALT and GGT levels and decreased AST/ALT levels are independent, additive risk factors for type 2 diabetes and prediabetes.
  • ALT levels seem to be the most predictive of the risk of type 2 diabetes in women.

Ko SH, Baeg MK, Han KD, and et al. “Increased liver markers are associated with higher risk of type 2 diabetes.” World Journal of Gastroenterology 21.24 (2015): 7478-7487. n. pag. Web. 7 July 2015.