ArticleBMC primary care2025
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.
Article in BMC primary care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Determinants of Metabolic Dysfunction-Associated Steatotic Liver Diseases in Patients with Type 2 Diabetes Mellitus.Journal of clinical medicine · 2026Article
- Association of the fibrosis-4 index with prevalent diabetes among adults: a cross-sectional analysis of NHANES 2003-2018 and a Chinese hospital-based health examination population.Frontiers in endocrinology · 2026Article
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11 authors.
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Abstract
backgroundType 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.
methodsWe 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.
resultsAmong 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.
conclusionMore 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.
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