1414-P: Patients with Type 2 Diabetes and Nonalcoholic Fatty Liver Disease Experience Significant Disease Burden and Stigma
Authors: YOUNOSSI ZOBAIR , YILMAZ YUSUF , FAN JIAN-GAO , ZHENG MING-HUA , AIDA ALSWAT KHALID , ALQAHTANI SALEH , EL-KASSAS MOHAMED , CASTERA LAURENT , FUNUYET-SALAS JESUS , ROMERO-GOMEZ MANUEL , WONG VINCENT W. , ZELBER-SAGI SHIRA , TREEPRASERTSUK SOMBAT , ALLEN ALINA , TAKAHASHI HIROKAZU , KAWAGUCHI TAKUMI , FRANCQUE SVEN , DUSEJA AJAY , SCHATTENBERG JOERN M. , BURRA PATRIZIA , CARRIERI PATRIZIA , ARRESE MARCO , EGUCHI YUICHIRO , SINGAL ASHWANI , GORDON STUART , HENRY LINDA , CUSI KENNETH , GOLABI PEGAH , STEPANOVA MARIA , LAZARUS JEFFREY V. 
Published: June 2024

Introduction & Objective: Type 2 diabetes (T2D) and obesity are associated with metabolic dysfunction-associated steatotic liver disease formerly known as NAFLD. Our aim was to understand stigma and disease burden among NAFLD patients with T2D.
Methods: Members of the Global NASH Council created a 68-item survey about patients’ experience with NAFLD, history of stigma-discrimination and various aspects of the disease burden (Liver Disease Burden instrument-LDB). In this study, we included only NAFLD patients who reported having a history of T2D or hyperglycemia.
Results: The survey was completed by 1,976 NAFLD patients from 23 countries, of which 578 (29%) reported having T2D (59% ≥55 years of age, 52% male, 60% obese). There were 28% who reported having experienced stigma or discrimination due to their T2D vs. 42% due to overweight/obesity and 16% due to NAFLD. Of all patients with T2D, 23-30% (vs. 7-10%) reported ever missing or avoiding a visit provider due to stigma. T2D reported missing medical visits more commonly (all p&lt;0.0001). Using the LDB, the greatest social-emotional burden among patients with T2D was feeling like they are partially to blame for their disease (49%). Among 7 LDB domains, the highest scores were observed in the Self-Perception and Stigma domains although all LDB domain scores were significantly higher in patients with T2D who reported a history of stigmatization due to T2D. Up to 25% of patients with T2D reported that they felt ashamed or were bothered that their liver disease had the word “fatty”, including 40% of T2D patients with history of stigmatization due to DM. Regarding specific diagnostic terms for NAFLD, between 22-29% diabetics reported being uncomfortable with either “fatty liver”, “NAFLD”, “NASH” or “MAFLD”.
Conclusions: The disease burden and disease-related stigma are commonly observed in T2D patients with NAFLD. Stigmatization is strongly associated with healthcare avoidance and, overall, a greater disease burden in NAFLD.

Disclosure
Z. Younossi: Consultant; Gilead Sciences, Inc., Bainan Biotech, AbbVie Inc., Bristol-Myers Squibb Company, Abbott, Novo Nordisk, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Siemens Healthcare Diagnostics, Intercept Pharmaceuticals, Inc. Y. Yilmaz: Consultant; Zydus Lifesciences, Novo Nordisk. J. Fan: None. M. Zheng: None. K. Alswat: None. S. Alqahtani: Consultant; AbbVie Inc., Bristol-Myers Squibb Company, Merck & Co., Inc., Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc. M. El-Kassas: Consultant; AstraZeneca. L. Castera: Speaker's Bureau; Echosens. Advisory Panel; GlaxoSmithKline plc. Speaker's Bureau; Madrigal Pharmaceuticals, Inc. Advisory Panel; Merck & Co., Inc. Speaker's Bureau; Novo Nordisk. Advisory Panel; Pfizer Inc., Sagimet Biosciences, Siemens Healthcare Diagnostics. J. Funuyet-Salas: None. M. Romero-Gomez: Research Support; Gilead Sciences, Inc., AbbVie Inc., Novo Nordisk, Echosens, Siemens Healthcare Diagnostics. Consultant; Merck & Co., Inc., ProSciento, Boehringer-Ingelheim. Research Support; Apollo Endosurgery. V.W. Wong: Consultant; AbbVie Inc., Boehringer-Ingelheim, Echosens, Gilead Sciences, Inc. Research Support; Gilead Sciences, Inc. Consultant; Intercept Pharmaceuticals, Inc., Inventiva Pharma, Novo Nordisk, Pfizer Inc., Sagimet Biosciences. S. Zelber-Sagi: None. S. Treeprasertsuk: None. A. Allen: Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk, Pfizer Inc., TARGET PharmaSolutions, Inc. Advisory Panel; Boehringer-Ingelheim. H. Takahashi: None. T. Kawaguchi: None. S. Francque: None. A. Duseja: None. J.M. Schattenberg: None. P. Burra: None. P. Carrieri: None. M. Arrese: None. Y. Eguchi: None. A. Singal: None. S. Gordon: Advisory Panel; GlaxoSmithKline plc, Ipsen, CymaBay. Research Support; CymaBay, Ipsen. Advisory Panel; Gilead Sciences, Inc. Research Support; Gilead Sciences, Inc. L. Henry: None. K. Cusi: Research Support; Echosens, Boehringer-Ingelheim, Quest Diagnostics, Inventiva Pharma, LabCorp, Nordic Bioscience A/S. Consultant; Arrowhead Pharmaceuticals, Inc., AstraZeneca, Boehringer-Ingelheim, Lilly Diabetes, 89bio, Inc., GlaxoSmithKline plc, Novo Nordisk, Siemens Healthcare Diagnostics, Sagimet Biosciences, Terns Pharmaceuticals. P. Golabi: None. M. Stepanova: None. J.V. Lazarus: None.