Abstract / Summary
Ultrasound-derived fat fraction (UDFF) is a quantitative imaging measure of hepatic fat content, but its associations with glycemic control and metabolic abnormalities in patients with type 2 diabetes mellitus (T2DM) remain unclear. This study primarily investigated whether UDFF was associated with poor glycemic control in patients with T2DM and further explored its associations with metabolic abnormalities and chronic diabetes-related complications. This single-center, retrospective, cross-sectional study included 759 hospitalized patients with T2DM who underwent UDFF assessment between August 2023 and February 2026. UDFF was analyzed as a continuous variable and by quartiles. Poor glycemic control was defined as glycated hemoglobin (HbA1c) ≥ 7.0%. Spearman correlation, multivariable regression, restricted cubic spline, subgroup, and sensitivity analyses were performed. The fully adjusted model included age, sex, diabetes duration, body mass index (BMI), and hypertension. Among the 759 patients, the median age was 63.0 years (Q1–Q3, 54.0–71.0) and the median UDFF was 8.0% (Q1–Q3, 4.0–13.0; range, 2.0%–43.0%). UDFF-defined hepatic steatosis was present in 385 patients (50.7%). Each 5-percentage-point increase in UDFF was associated with higher odds of poor glycemic control (odds ratio [OR], 1.253; 95% confidence interval [CI], 1.070–1.468; P = 0.005), but not with continuous HbA1c after full adjustment (B = 0.016percentage points; 95% CI, − 0.101 to 0.133; P = 0.792). Restricted cubic spline analysis showed an overall association ( P = 0.040) without evidence of nonlinearity ( P = 0.567). The association remained significant after additional adjustment for glucose-lowering medications and in the liver-related sensitivity analysis. Higher UDFF correlated with body mass index, triglycerides, the triglyceride-to-high-density lipoprotein cholesterol ratio, and liver enzyme levels, and inversely with high-density lipoprotein cholesterol. Regarding chronic diabetes-related complications, UDFF showed no consistent positive association after multivariable adjustment. Higher UDFF was associated with greater odds of poor glycemic control and an unfavorable metabolic profile in hospitalized patients with T2DM, but not with HbA1c analyzed continuously. UDFF may provide complementary quantitative information regarding hepatic fat burden and poor glycemic control. Prospective studies with longitudinal treatment information are needed to clarify this relationship.