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Chanda e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
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O iginal Resea ch A icle
P e alence o Li e Func ion Tes Abno mali y and Associa ed Fac o s in
Type 2 Diabe es Melli us: A Compa a i e C oss-Sec ional S udy
Sangi a Chanda1, Biswana h Sha ma Sa ka 2, P o yush Chak abo y3
1Senio Residen , MBBS, MD (Biochemis y), Depa men o Biochemis y, Raiganj Go e nmen Medical
College and Hospi al, Raiganj, Wes Bengal 733134
2P o esso and Head o he Depa men , MBBS, MD (Medicine), Depa men o Medicine, In ec ious
Diseases & Belegha a Gene al Hospi al, Belegha a, Kolka a, Wes Bengal 700010
3Medical O ice In-Cha ge, MBBS, Ja adanga P ima y Heal h Cen e, Ja adanga, Old Malda,Wes
Bengal 732141
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 14-08-2025
Co esponding Au ho : D . Sangi a Chanda
Con lic o in e es : Nil
Abs ac
In oduc ion: Type 2 diabe es melli us (T2DM) is associa ed wi h a a ie y o hepa ic abno mali ies, anging
om non-alcoholic a y li e disease (NAFLD) o ad anced ib osis, o en e lec ed by al e a ions in li e
unc ion es s (LFTs). Ea ly de ec ion o such abno mali ies is impo an o comp ehensi e managemen and
p e en ion o complica ions.
Objec i es: To de e mine he p e alence o li e unc ion es abno mali ies in pa ien s wi h T2DM and o
iden i y associa ed clinical and biochemical ac o s, compa ed wi h non-diabe ic con ols.
Me hods: This compa a i e c oss-sec ional s udy was conduc ed o e a pe iod o one yea a Raiganj
Go e nmen Medical College and Hospi al. A o al o 100 adul pa ien s diagnosed wi h ype 2 diabe es melli us
a ending he ou pa ien depa men we e en olled. The s udy a iables included demog aphic ac o s such as
age, sex dis ibu ion (male and emale), du a ion o diabe es, and body mass index (BMI). Labo a o y
pa ame e s assessed, comp ised glycosyla ed hemoglobin (HbA1c) and li e unc ion es s including alanine
amino ans e ase (ALT), aspa a e amino ans e ase (AST), alkaline phospha ase (ALP), bili ubin, and albumin
le els. Da a we e collec ed h ough pa ien in e iews, clinical examina ions, and biochemical in es iga ions.
The aim was o compa e li e unc ion pa ame e s and hei associa ion wi h glycemic con ol and diabe es
du a ion among ype 2 diabe ic pa ien s.
Resul s: Li e unc ion es abno mali ies a e common in pa ien s wi h ype 2 diabe es melli us, wi h ele a ed
ALT and AST le els obse ed in 38% and 34% o pa ien s, espec i ely. These abno mali ies we e signi ican ly
associa ed wi h poo glycemic con ol and highe BMI. Pa ien s wi h HbA1c ≥7% had signi ican ly highe ALT
and AST le els and lowe albumin compa ed o hose wi h be e glycemic con ol. Addi ionally, he p e alence
o ele a ed li e enzymes inc eased p og essi ely wi h highe BMI ca ego ies. Mul i a ia e analysis iden i ied
male sex, longe diabe es du a ion (≥5 yea s), o e weigh /obesi y (BMI ≥25 kg/m²), and poo glycemic con ol
as independen isk ac o s o li e dys unc ion, wi h poo glycemic con ol being he s onges p edic o .
Conclusion: LFT abno mali ies a e common in pa ien s wi h T2DM and a e associa ed wi h obesi y, longe
disease du a ion, poo glycemic con ol, and dyslipidemia. Rou ine moni o ing o li e enzymes in T2DM
pa ien s may help in ea ly iden i ica ion and managemen o unde lying hepa ic diso de s.
Keywo ds: Type 2 diabe es melli us, li e unc ion es s, alanine amino ans e ase, aspa a e amino ans e ase,
non-alcoholic a y li e disease, dyslipidemia.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
Type 2 diabe es melli us (T2DM) has eme ged as a
global heal h challenge, wi h i s me abolic
de angemen s ex ending well beyond glucose
homeos asis o in ol e mul iple o gan sys ems.
One such sys em is he li e , which is equen ly
a ec ed by me abolic dys unc ion-associa ed
s ea o ic li e disease (MASLD), o me ly known
as non-alcoholic a y li e disease (NAFLD) [1].
MASLD has become he mos common cause o
ch onic li e disease in adul s, pa alleling ising
a es o obesi y and T2DM globally. Among
indi iduals wi h T2DM, MASLD p e alence
exceeds 60% and may app oach nea ly uni e sal
le els in hose wi h se e e obesi y. The clinical
spec um spans om simple s ea osis o me abolic
dys unc ion-associa ed s ea ohepa i is (MASH),
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which inc eases isks o ib osis, ci hosis, and
hepa ocellula ca cinoma [2].
Rou ine li e unc ion es s (LFTs) — including
ALT, AST, ALP, bili ubin, and GGT — a e
equen ly abno mal in pa ien s wi h T2DM,
e lec ing unde lying hepa ic cellula inju y o
choles asis [3]. Ele a ed LFTs may indica e insulin
esis ance, subclinical s ea osis, o p og ession
owa ds s ea ohepa i is [4]. Epidemiological s udies
in di e se popula ions ha e epo ed a ying
p e alence a es; o ins ance, in China, ele a ed
ALT and AST we e ound in 10.3% and 6.1% o
T2DM pa ien s, espec i ely, wi h male sex,
obesi y, hype ension, hype iglyce idemia, and
alcohol in ake iden i ied as signi ican associa es
[5]. In No h Indian adul s, 62.5% o T2DM
subjec s exhibi ed de anged LFTs—signi ican ly
highe han in non-diabe ic con ols—unde sco ing
egion-speci ic epidemiological ends [6].
Fu he , s udies analyzing me abolic synd ome
componen s epo ele a ed li e enzymes in
app oxima ely 16%, 9%, and 23% o T2DM
pa ien s o ALT, AST, and GGT espec i ely, wi h
s ong links o obesi y, dyslipidemia, and poo
glycemic con ol [7]. In Bangladesh, a compa a i e
c oss-sec ional s udy e ealed ha 58% o T2DM
pa ien s had a leas one LFT abno mali y, wi h
ALT ele a ion, p olonged p o h ombin ime, and
hypoalbuminemia among he common indings [8].
No ably, a y li e on ul asound was obse ed in
o e hal o T2DM pa icipan s, consis en wi h
global imaging ends [9].
The p esence o MASLD o MASH in T2DM has
b oade implica ions han li e - ela ed mo bidi y
alone. Coexis ing hepa ic s ea osis o ele a ed
LFTs con ibu es o ampli ied ca dio ascula isk
and p og ession o ad anced li e disease,
including ci hosis and hepa ocellula ca cinoma
[10]. Gi en he inc easing global bu den and
unde diagnosis o agg essi e a y li e disease in
T2DM— ecen es ima es sugges ha wo- hi ds o
T2DM indi iduals ha e MASLD while many
emain undiagnosed— he e is an u gen need o
imp o ed sc eening and isk s a i ica ion. Taken
oge he , he high p e alence o LFT abno mali ies
in T2DM, hei eliable associa ions wi h obesi y,
dyslipidemia, hype ension, and poo glycemic
con ol, and hei implica ions o disease
p og ession and como bidi y unde sco e he
clinical impo ance. Howe e , compa a i e s udies
be ween diabe ic and non-diabe ic popula ions
ac oss di e se geog aphic and clinical se ings
emain limi ed.
Ma e ials and Me hods
S udy Design: Compa a i e c oss-sec ional s udy.
Place o s udy: Raiganj Go Medical College and
Hospi al.
Pe iod o s udy: 1 yea .
S udy Va iables
• Age
• Male
• Female
• Du a ion o Diabe es
• BMI
• HbA1c
• LFT Pa ame e
• ALT
• AST
• ALP
• Bili ubin
• Albumin
Sample size: 100 Adul pa ien s diagnosed wi h
ype 2 diabe es melli us a ending he ou pa ien
depa men .
Inclusion C i e ia
• Adul s aged 40-60 yea s
• Diagnosed cases o ype 2 diabe es melli us
(pe ADA c i e ia).
• Age- and sex-ma ched non-diabe ic con ols
o compa ison.
• Willingness o p o ide in o med consen .
Exclusion C i e ia
• His o y o ch onic li e disease ( i al hepa i is,
au oimmune hepa i is, ci hosis).
• Signi ican alcohol consump ion (>20 g/day
o women, >30 g/day o men).
• Cu en use o hepa o oxic d ugs.
• P egnancy o lac a ion.
• Acu e illness o in ec ion a he ime o s udy.
• Unwillingness o pa icipa e.
S a is ical Analysis: Da a we e en e ed in o
Mic oso Excel and analyzed using S a is ical
Package o he Social Sciences (SPSS) so wa e,
Con inuous a iables we e exp essed as mean ±
s anda d de ia ion (SD) and compa ed be ween
g oups using he independen samples - es o
no mally dis ibu ed da a o he Mann–Whi ney U
es o non-no mally dis ibu ed da a. Ca ego ical
a iables we e exp essed as equencies and
pe cen ages, and associa ions be ween g oups we e
assessed using he Chi-squa e es o Fishe ’s exac
es , as app op ia e. Logis ic eg ession analysis
was pe o med o iden i y independen p edic o s
o li e unc ion es abno mali ies among ype 2
diabe es melli us pa ien s. A p- alue < 0.05 was
conside ed s a is ically signi ican .
Resul
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Chanda e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1097
Table 1: Baseline Cha ac e is ics o he S udy Popula ion (n = 100)
Va iable
Mean ± SD / n (%)
Age (yea s)
54.6 ± 8.9
Male
58 (58.0%)
Female
42 (42.0%)
Du a ion o Diabe es (yea s)
7.8 ± 4.2
BMI (kg/m²)
27.3 ± 3.8
HbA1c (%)
8.2 ± 1.4
Table 2: P e alence o Li e Func ion Tes (LFT) Abno mali ies
LFT Pa ame e
Abno mal n (%)
No mal n (%)
p- alue
ALT (>40 U/L)
38 (38.0%)
62 (62.0%)
0.002
AST (>40 U/L)
34 (34.0%)
66 (66.0%)
0.005
ALP (>120 U/L)
22 (22.0%)
78 (78.0%)
0.041
To al Bili ubin (>1.2)
8 (8.0%)
92 (92.0%)
0.311
Albumin (<3.5 g/dL)
12 (12.0%)
88 (88.0%)
0.152
Table 3: Compa ison o Mean LFT Values be ween Type 2 Diabe es Pa ien s wi h and wi hou Poo
Glycemic Con ol (HbA1c ≥7%)
Pa ame e
HbA1c < 7% (n = 32) Mean ± SD
HbA1c ≥ 7% (n = 68) Mean ± SD
p- alue
ALT (U/L)
32.4 ± 9.8
45.7 ± 15.2
0.001
AST (U/L)
30.2 ± 8.5
41.6 ± 13.9
0.002
ALP (U/L)
105.3 ± 20.6
112.8 ± 25.4
0.118
Bili ubin (mg/dL)
0.78 ± 0.21
0.81 ± 0.25
0.543
Albumin (g/dL)
4.1 ± 0.4
3.8 ± 0.5
0.029
Table 4: Associa ion be ween BMI and LFT Abno mali ies
BMI Ca ego y (kg/m²)
ALT Abno mal (%)
AST Abno mal (%)
p- alue (ALT)
p- alue (AST)
No mal (<25)
9 (23.1%)
7 (17.9%)
0.011
0.018
O e weigh (25–29.9)
17 (40.5%)
16 (38.1%)
Obese (≥30)
12 (60.0%)
11 (55.0%)
Table 5: Mul i a ia e Logis ic Reg ession o P edic o s o LFT Abno mali y
Va iable
Adjus ed OR
95% CI
p- alue
Male sex
1.82
1.04 – 3.21
0.037
Du a ion o DM ≥ 5 yea s
2.45
1.28 – 4.67
0.006
BMI ≥ 25 kg/m²
2.72
1.49 – 4.95
0.001
Poo glycemic con ol
3.14
1.68 – 5.86
<0.001
Figu e 1: P e alence o Li e Func ion Tes (LFT) Abno mali ies
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Chanda e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1098
Figu e 2: Compa ison o Mean LFT Values be ween Type 2 Diabe es Pa ien s wi h and wi hou Poo
Glycemic Con ol (HbA1c ≥7%)
In ou s udy, he mean age o he pa icipan s was
54.6 ± 8.9 yea s. The e was a sligh male
p edominance, wi h 58 (58.0%) males and 42
(42.0%) emales. The a e age du a ion o diabe es
among he pa ien s was 7.8 ± 4.2 yea s. The mean
body mass index (BMI) was 27.3 ± 3.8 kg/m², a
subs an ial p opo ion o he s udy popula ion was
o e weigh . The mean glyca ed hemoglobin
(HbA1c) le el was 8.2 ± 1.4%, sugges ing ha , on
a e age, pa ien s had subop imal glycemic con ol.
In he p esen s udy, ele a ed alanine
amino ans e ase (ALT) le els (>40 U/L) we e
obse ed in 38 pa ien s (38.0%), which was
s a is ically signi ican (p = 0.002). Aspa a e
amino ans e ase (AST) ele a ion (>40 U/L) was
no ed in 34 pa ien s (34.0%) wi h a signi ican
associa ion (p = 0.005). Alkaline phospha ase
(ALP) ele a ion (>120 U/L) was ound in 22
pa ien s (22.0%) and was also s a is ically
signi ican (p = 0.041). In con as , o al bili ubin
le els abo e 1.2 mg/dL we e seen in only 8 pa ien s
(8.0%), and hypoalbuminemia (<3.5 g/dL) in 12
pa ien s (12.0%), nei he o which showed
s a is ical signi icance (p = 0.311 and p = 0.152,
espec i ely).
When compa ing li e unc ion pa ame e s
be ween pa ien s wi h good glycemic con ol
(HbA1c < 7%) and hose wi h poo glycemic
con ol (HbA1c ≥ 7%), signi ican ly highe mean
ALT (45.7 ± 15.2 U/L s. 32.4 ± 9.8 U/L, p =
0.001) and AST (41.6 ± 13.9 U/L s. 30.2 ± 8.5
U/L, p = 0.002) le els we e obse ed in he poo
con ol g oup. Mean ALP le els we e sligh ly
highe in he poo con ol g oup (112.8 ± 25.4 U/L
s. 105.3 ± 20.6 U/L), bu his di e ence was no
s a is ically signi ican (p = 0.118). Mean o al
bili ubin alues we e compa able be ween g oups
(0.81 ± 0.25 mg/dL s. 0.78 ± 0.21 mg/dL, p =
0.543). Albumin le els we e signi ican ly lowe in
pa ien s wi h poo glycemic con ol compa ed o
hose wi h good con ol (3.8 ± 0.5 g/dL s. 4.1 ±
0.4 g/dL, p = 0.029).
The p e alence o abno mal ALT and AST le els
showed a signi ican associa ion wi h BMI
ca ego ies. Among pa ien s wi h a no mal BMI
(<25 kg/m²), 23.1% had ele a ed ALT and 17.9%
had ele a ed AST le els. This p e alence inc eased
in he o e weigh g oup (25–29.9 kg/m²), wi h
40.5% showing ALT abno mali ies and 38.1%
showing AST abno mali ies. The highes
p e alence was obse ed in he obese g oup (≥30
kg/m²), whe e 60.0% had abno mal ALT and
55.0% had abno mal AST le els. The di e ences
in ALT and AST abno mali ies ac oss BMI
ca ego ies we e s a is ically signi ican , wi h p-
alues o 0.011 and 0.018, espec i ely.
Mul i a ia e logis ic eg ession analysis iden i ied
se e al independen p edic o s o li e unc ion es
abno mali ies in pa ien s wi h ype 2 diabe es
melli us. Male sex was associa ed wi h a 1.82- old
inc eased isk o LFT abno mali ies (adjus ed OR:
1.82; 95% CI: 1.04–3.21; p = 0.037). A du a ion o
diabe es o 5 yea s o mo e signi ican ly inc eased
he odds by 2.45 imes (adjus ed OR: 2.45; 95% CI:
1.28–4.67; p = 0.006). Pa ien s wi h a BMI ≥ 25
kg/m² had a 2.72- old highe isk o abno mal li e
unc ion (adjus ed OR: 2.72; 95% CI: 1.49–4.95; p
= 0.001). Poo glycemic con ol eme ged as he
s onges p edic o , wi h a mo e han h ee old
inc eased isk (adjus ed OR: 3.14; 95% CI: 1.68–
5.86; p < 0.001).
Discussion
The p esen s udy shows a subs an ial p e alence o
li e unc ion es (LFT) abno mali ies among
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1099
pa ien s wi h ype 2 diabe es melli us (T2DM),
consis en wi h indings om p e ious esea ch.
The o e all p e alence o ele a ed ALT (38.0%)
and AST (34.0%) in ou coho is compa able o
he anges epo ed by Fa aha e al. [1] and Zhang
e al. [2], who obse ed ele a ed ansaminases in
30–45% o diabe ic popula ions. The signi ican
associa ion o abno mal ALT and AST le els wi h
poo glycemic con ol in ou s udy ein o ces he
concep ha hype glycemia con ibu es o hepa ic
inju y, likely h ough mechanisms such as insulin
esis ance and oxida i e s ess [3,4]. Simila
indings we e epo ed by Al-Daydamony and El-
Sayed [5], who ound ha highe HbA1c le els
we e s ongly co ela ed wi h inc eased li e
enzymes. The impac o BMI on li e abno mali ies
was e iden , wi h obese pa ien s showing he
highes p e alence o ALT and AST ele a ion,
suppo ing he well-es ablished link be ween
obesi y, nonalcoholic a y li e disease (NAFLD),
and li e enzyme ele a ion in T2DM [6,7]. This
associa ion was also con i med by Singh e al. [8]
and Khei andish-Gozal e al. [9], emphasizing he
impo ance o weigh managemen in diabe ic
pa ien s o mi iga e hepa ic complica ions. Ou
logis ic eg ession analysis iden i ied male sex,
longe diabe es du a ion, o e weigh /obesi y, and
poo glycemic con ol as independen p edic o s o
LFT abno mali ies.
These indings align wi h hose o Ta ghe e al.
[10], who documen ed simila isk ac o s o
NAFLD in diabe es. The s onge p edic i e alue
o poo glycemic con ol obse ed in ou s udy
unde lines he need o s ingen me abolic
managemen o p e en p og essi e li e damage in
his popula ion. In conclusion, he s udy adds o he
g owing body o e idence ha li e dys unc ion is
a common como bidi y in T2DM and is s ongly
in luenced by modi iable ac o s such as glycemic
con ol and BMI. Ea ly de ec ion and in e en ion
a e c ucial o imp o ing pa ien ou comes and
p e en ing long- e m hepa ic complica ions.
Conclusion
In conclusion, his s udy demons a es a high
p e alence o li e unc ion es abno mali ies
among pa ien s wi h ype 2 diabe es melli us, wi h
ele a ed ALT and AST le els being he mos
common indings. Poo glycemic con ol, inc eased
BMI, longe du a ion o diabe es, and male sex
we e iden i ied as signi ican independen
p edic o s o li e dys unc ion.
These indings unde sco e he impo ance o
egula moni o ing o li e enzymes in diabe ic
pa ien s, especially hose wi h uncon olled blood
suga le els and highe body weigh . Ea ly
de ec ion and managemen o li e abno mali ies
can help p e en p og ession o mo e se e e
hepa ic complica ions such as nonalcoholic a y
li e disease and ci hosis. The e o e, in eg a ed
ca e ocusing on op imal glycemic con ol and
weigh managemen should be p io i ized o
imp o e o e all li e heal h and educe mo bidi y
in his popula ion.
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