The circulating hepatic markers of alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio and fetuin-A are early risk indicators of type 2 diabetes in women, according to a study published in The Journal of Clinical Endocrinology and Metabolism.
Researchers assessed women during pregnancy with an oral glucose challenge test and an oral glucose tolerance test. They also conducted follow-ups at 1- and 3-years postpartum with an oral glucose tolerance test and liver enzyme analysis. At baseline, the women were grouped according to glucose levels; normal glucose levels (n=75), abnormal glucose challenge test but normal oral glucose tolerance test (n=98), gestational impaired glucose tolerance (n=59), and gestational diabetes (n=104).
While the circulating hepatic markers of ALT, AST, gamma-glutamyltransferase, and fetuin-A did not differ between the 4 groups in predicting risk for diabetes, changes in ALT/AST ratio and fetuin-A had the strongest independent association with future reductions in insulin sensitivity between 1 and 3 years (P <.0001 for both). Also, increases in the ALT/AST ratio between year 1 and 3 were associated with poor beta-cell function (P =.001) and high fasting glucose (P =.01). Fetuin-A levels at 1 year postpartum were associated with developing pre-diabetes or diabetes by year 3 (odds ratio 1.38).
In conclusion, there appears to be a pathophysiological relationship between the circulating hepatic markers of ALT/AST ratio and fetuin-A on detecting risk for type 2 diabetes in women.
This study was supported by operating grants from Canadian Institutes of Health Research and Canadian Diabetes Association.
Pinnaduwage L, Ye C, Hanley AJ, et al. Changes over time in hepatic markers predict changes in insulin sensitivity, beta-cell function and glycemia. J Clin Endocrinol Metab. 2018; 103(7):2651-2659.