P1282 Type 2 diabetes mellitus in IBD patients: a case control study through a long follow up period
Authors: Zaccardi B , Ribaldone D G 
Published: January 2025

Abstract

Background
The characterization of patients with Inflammatory Bowel disease (IBD) and Type 2 Diabetes Mellitus (T2DM), as a new category, has not been detailed yet. The main endpoint was evaluating how diabetes may affect IBD course. Additionally, we analysed the prevalence of liver steatosis and liver damage in these patients.

Methods
We conducted a retrospective case-control study, comparing the occurrence of a severe IBD in patients with IBD+T2DM (cases) versus patients with IBD alone (controls). Among 1047 medical records, we selected all the patients with IBD-T2DM, randomly choosing controls in a 1:4 ratio. We defined severe IBD as the occurrence of at least one of the following factors: IBD-related surgery; initiation of target therapy; over two courses of systemic corticosteroids in a year; IBD-related hospitalization; diarrhoea for more than 12 months with nocturnal awakenings/urgency; symptomatic intestinal stenosis. We defined liver damage as a Fib-4 value &gt; 1.3; hepatic steatosis was assessed via instrumental exams.

Results
We included 79 IBD-T2DM patients comparing them with 308 patients with IBD alone. The presence of a severe disease was similar in the two groups (59.5% vs 59.7%; p=0.97). Statistically significant differences emerged about the presence of hepatic steatosis (62.9%vs 27.2%; p&lt;0.0001) and liver damage (55.4% vs 26.6%; p&lt;0.0001). In univariate analysis, hypertension (HR: 1.61; p = 0.047), dyslipidaemia (HR: 1.68. p = 0.03) and being naïve to thiopurines (HR: 1.81 p = 0.02) contribute to increase liver damage risk, though these variables were not significant in multivariate analysis. In the IBD-T2DM group, we found a higher current (2.6% vs 1.4%) and past (64.9% vs 34.7%; p&lt;0.0001) use of systemic corticosteroids and a lower current (7.6% vs 12.8%) and past (7.6% vs 20.2%) use of anti-TNF-alpha drugs (p=0.007). Median age at diagnosis of IBD was higher in cases (48.0 vs 32.0; p &lt; 0.0001). In a sub-analysis of Crohn’s disease (CD), 24.3% of the CD-T2DM group had an exclusively colonic involvement vs 5% in the group without T2DM (p=0.003).

Conclusion
In our study, T2DM was not associated with an IBD worse clinical course. Secondly, we observed an increased presence of steatosis and liver injury, but the IBD-T2DM combination was not a multiplicative risk factor for these outcomes. In clinical practice, we observed a larger use of systemic corticosteroids and a lower use of anti-TNF-alpha drugs in IBD-T2DM patients. Differences such as age of disease onset, colonic involvement, and liver damage, suggest that IBD-T2DM patients could configure a special population worthy of further studies.

References
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CDC. National Diabetes Statistics Report. Diabetes. Published June 6, 2024. Accessed June 12, 2024.https://www.cdc.gov/diabetes/php/data-research/index.html
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